椎管内阻滞对麻醉深度的影响
摘要
目的：比较硬膜外阻滞-气管内插管联合麻醉对麻醉深度的影响。
方法：42例ASAⅠ-Ⅱ级剖胸手术病人，随机双盲法平分为两组：Ⅰ组全
麻组(n=21)；Ⅱ组硬膜外阻滞-气管内插管联合麻醉组(n=21)。所有病人均
放置脑电双频谱指数(BIS)监测，均接受硬膜外穿刺。Ⅰ组在硬膜外注入
生理盐水；Ⅱ组硬膜外注入0.25％布比卡因。所有病人诱导用药一致，术中
均以异丙酚和维库溴铵微量泵泵入，芬太尼间断静注。根据有创血压调节
异丙酚泵入速度维持血流动力学平稳。两组均在关好胸腔后停用维库溴铵，
缝皮前停用异丙酚。术毕24小时内随访病人，查询有先术中知晓。
结果：(1)在相同的剂量诱导后，两组BIS值均明显下降(P＜0.05)，组
间在各时点的BIS值无差别。(2)术中BIS平均值：Ⅰ组明显低于Ⅱ组
(P＜0.05)；术中每公斤体重异丙酚用量：Ⅰ组明显高于Ⅱ组(P＜0.05)。(3)
停药(异丙酚)到意识恢复；完全清醒；拔管的时间Ⅰ组长于Ⅱ组(P＜0.05)，
两组在各时的BIS值无差别。(4)两组术后24小时随访，无一例发生术
中知晓。
结论：硬膜外阻滞-气管内插管联合麻醉使全麻药量减少，术后恢复快，
并未增加术中知晓发生率。
Objective: To compare the effect of general anesthesia and combined epidural-general anesthesia on the depth of anesthesia. Methods: 42 ASA I - II patients undergoing elective thoracic surgery were divided into two groups using a prospective double-blind design: Group I, general anesthesia (n=21), group II, combined epidural-general anesthesia (n=21). Bispectral index (BIS) was continuously monitored in both groups during the surgery. All patients received epidural puncture and catheterizing. Patients in group I received epidural normal salt while the patients in group II received epidurally 0.25% bupivacaine. All the patients in both groups received same drug for anesthesia induction and the anesthesia was maintained with propofol and vecuronium infusion, fentanyl was injected intravenously as necessary. According to invasive blood pressure, the rate of propofol infusion was adjusted to keep homodynamic stable. Vecuronium infusion was stopped after thorax was closed and propofol infusion was stopped before skin was sutured. All patients were asked for awareness during the surgery in postoperative 24 hours.
Results: (1) In both groups the BIS scores reduced after induction (P<0.05). There was no significant difference between the two groups (P>0.05). (2) The
average of the BIS scores during the surgery were lower in group I than in group II (P<0.05). The amount of propofol used significantly more in group I compared to that of group II (P<0.05). (3) The time of recovery, awakening and extubation was longer in group I than in group II (PO.05), but there was no significant difference in the BIS scores at the time of recovery, awakening and extubation between the two groups. (4) No single case of awareness during the surgery happened in postoperative 24 hours investigation.
Conclusion: Compared with general anesthesia, combined epidural-general anesthesia reduced the dosages of anesthetics without increasing of awareness during the surgery. Combined epidural-general anesthesia also made the patients recovery from the anesthesia more quickly.
方法：42例ASAⅠ-Ⅱ级剖胸手术病人，随机双盲法平分为两组：Ⅰ组全
麻组(n=21)；Ⅱ组硬膜外阻滞-气管内插管联合麻醉组(n=21)。所有病人均
放置脑电双频谱指数(BIS)监测，均接受硬膜外穿刺。Ⅰ组在硬膜外注入
生理盐水；Ⅱ组硬膜外注入0.25％布比卡因。所有病人诱导用药一致，术中
均以异丙酚和维库溴铵微量泵泵入，芬太尼间断静注。根据有创血压调节
异丙酚泵入速度维持血流动力学平稳。两组均在关好胸腔后停用维库溴铵，
缝皮前停用异丙酚。术毕24小时内随访病人，查询有先术中知晓。
结果：(1)在相同的剂量诱导后，两组BIS值均明显下降(P＜0.05)，组
间在各时点的BIS值无差别。(2)术中BIS平均值：Ⅰ组明显低于Ⅱ组
(P＜0.05)；术中每公斤体重异丙酚用量：Ⅰ组明显高于Ⅱ组(P＜0.05)。(3)
停药(异丙酚)到意识恢复；完全清醒；拔管的时间Ⅰ组长于Ⅱ组(P＜0.05)，
两组在各时的BIS值无差别。(4)两组术后24小时随访，无一例发生术
中知晓。
结论：硬膜外阻滞-气管内插管联合麻醉使全麻药量减少，术后恢复快，
并未增加术中知晓发生率。
Objective: To compare the effect of general anesthesia and combined epidural-general anesthesia on the depth of anesthesia. Methods: 42 ASA I - II patients undergoing elective thoracic surgery were divided into two groups using a prospective double-blind design: Group I, general anesthesia (n=21), group II, combined epidural-general anesthesia (n=21). Bispectral index (BIS) was continuously monitored in both groups during the surgery. All patients received epidural puncture and catheterizing. Patients in group I received epidural normal salt while the patients in group II received epidurally 0.25% bupivacaine. All the patients in both groups received same drug for anesthesia induction and the anesthesia was maintained with propofol and vecuronium infusion, fentanyl was injected intravenously as necessary. According to invasive blood pressure, the rate of propofol infusion was adjusted to keep homodynamic stable. Vecuronium infusion was stopped after thorax was closed and propofol infusion was stopped before skin was sutured. All patients were asked for awareness during the surgery in postoperative 24 hours.
Results: (1) In both groups the BIS scores reduced after induction (P<0.05). There was no significant difference between the two groups (P>0.05). (2) The
average of the BIS scores during the surgery were lower in group I than in group II (P<0.05). The amount of propofol used significantly more in group I compared to that of group II (P<0.05). (3) The time of recovery, awakening and extubation was longer in group I than in group II (PO.05), but there was no significant difference in the BIS scores at the time of recovery, awakening and extubation between the two groups. (4) No single case of awareness during the surgery happened in postoperative 24 hours investigation.
Conclusion: Compared with general anesthesia, combined epidural-general anesthesia reduced the dosages of anesthetics without increasing of awareness during the surgery. Combined epidural-general anesthesia also made the patients recovery from the anesthesia more quickly.
引文
(1) 许明华，刘华平．全麻-硬膜外联合麻醉对内分泌及循环功能的影响．临床麻醉学杂志，2001，17：437
(2) 杭燕南，庄心良，蒋豪主编．当代麻醉学．第一版．上海：上海科学技术出版社，2002，954
(3) 徐启明，李文硕．临床麻醉学．第一版．北京：人民卫生出版社．2001，130-4
(4) 安刚，薛富善．现代麻醉学技术．第一版．北京：科学技术文献出版社，1999，658-9
(5) 王若松．静脉麻醉与药物输注学．北京：人民军医出版社，2001，59
(6) Leslie, MEES, FABZCA, et al. Propofol blood concentration and the bispectral index predict suppression of learning during propofol/epidural anesthesia in volunteers. Anesth-Analg, 1995, 81: 1269-74
(7) 杨铮，孙强，何静．全麻或复合硬膜外麻醉中麻醉深度的比较．广东医学，2000，21：667-8
(8) Hodgson P, Liu S, Gras T. Does epidural anesthesia have general anesthetics effects? A prospective, randomized, doubled-blind, place-controlled trial. Anesthesiology, 1999; 91: 1687-92
(9) Eappen S, Kissin I. Effect of subarachnoid bupivacaine block on anesthetic requirements forthiopental in rats. Anesthesiology, 1998; 88:1036-42
(10) Ben-David B, Vaida S, Gaitini L. The influence of high spinal anesthesia on sensitivity to midazolam sedation. Anesth Analg, 1995; 81:525-8
(11) Inagaki Y, Mashimo T, Kuzukawa A, et al. Epidural lidocaine deleys arousal from isoflurane anesthesia. Anesth Analg, 1994; 79:368-72
(12) 赵俊．新编麻醉学，第一版．北京：人民军医出版社，1999，981．
(13) Kerssens C, Klein J, Van A, et al. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index. Anesth-Analg, 2001, 92:1210-4
(14) Flaishon R, Windsor A. Recovery of consciousness after thiopental or propofol.
Bispectral index and isolated forearm technique. Anesthesiology, 1997, 86:613-9
(15) 贾宝森，岳云，柴伟．双频谱指数临床应用的某些进展．国外医学麻醉学与复苏分册，1999，20：162
(16) 徐富涛，顾晓萍，业光衡，等．咪唑安定和异丙酚联合诱导的临床观察．临床麻醉学杂志，2000，16：409
(2) 杭燕南，庄心良，蒋豪主编．当代麻醉学．第一版．上海：上海科学技术出版社，2002，954
(3) 徐启明，李文硕．临床麻醉学．第一版．北京：人民卫生出版社．2001，130-4
(4) 安刚，薛富善．现代麻醉学技术．第一版．北京：科学技术文献出版社，1999，658-9
(5) 王若松．静脉麻醉与药物输注学．北京：人民军医出版社，2001，59
(6) Leslie, MEES, FABZCA, et al. Propofol blood concentration and the bispectral index predict suppression of learning during propofol/epidural anesthesia in volunteers. Anesth-Analg, 1995, 81: 1269-74
(7) 杨铮，孙强，何静．全麻或复合硬膜外麻醉中麻醉深度的比较．广东医学，2000，21：667-8
(8) Hodgson P, Liu S, Gras T. Does epidural anesthesia have general anesthetics effects? A prospective, randomized, doubled-blind, place-controlled trial. Anesthesiology, 1999; 91: 1687-92
(9) Eappen S, Kissin I. Effect of subarachnoid bupivacaine block on anesthetic requirements forthiopental in rats. Anesthesiology, 1998; 88:1036-42
(10) Ben-David B, Vaida S, Gaitini L. The influence of high spinal anesthesia on sensitivity to midazolam sedation. Anesth Analg, 1995; 81:525-8
(11) Inagaki Y, Mashimo T, Kuzukawa A, et al. Epidural lidocaine deleys arousal from isoflurane anesthesia. Anesth Analg, 1994; 79:368-72
(12) 赵俊．新编麻醉学，第一版．北京：人民军医出版社，1999，981．
(13) Kerssens C, Klein J, Van A, et al. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index. Anesth-Analg, 2001, 92:1210-4
(14) Flaishon R, Windsor A. Recovery of consciousness after thiopental or propofol.
Bispectral index and isolated forearm technique. Anesthesiology, 1997, 86:613-9
(15) 贾宝森，岳云，柴伟．双频谱指数临床应用的某些进展．国外医学麻醉学与复苏分册，1999，20：162
(16) 徐富涛，顾晓萍，业光衡，等．咪唑安定和异丙酚联合诱导的临床观察．临床麻醉学杂志，2000，16：409