硬膜外麻醉下持续靶控输注丙泊酚的镇静效果

目的　评价丙泊酚靶控输注 (TCI)在硬膜外阻滞麻醉不同镇静分级时的脑电双频谱指数 (BIS)与生命体征变化。方法　择期硬膜外麻醉下行中下腹部手术的 5 3例患者 ,采用自身对照 ,比较在不同Ramsay分级时 ,丙泊酚靶控输注的效应部位浓度 (ESC)与BIS值生命体征变化。结果　在Ramsay 4级时的ESC为 (1.6 6± 0 .16 )mg·L-1,BIS为 78.5± 4 .6 ,生命体征平稳 ,其HR、MAP、RRS、SPO2 与Ramsay 2级比较无差异 (P >0 .0 5 ) ;与Ramsay 5级、6级比较差异有显著性 (P <0 .0 1)。结论　随着丙泊酚靶控输注的效应部位浓度的增加 ,BIS值呈计量相关性下降并能指导镇静分级。在硬膜外阻滞麻醉下Ramsay镇静 4级时较为适宜 ,生命体征平稳 ,并发症少

The sedative effect of propofol on target controlled infusion during epidural anesthesia

Objective To evaluate the bispectral (BIS) index of different sedation stages and vital signs during sedation produced by propofol with target-controlled infusion under epidural anesthesia. Methods Fifty-three patients scheduled for elective median and below abdomen surgery under epidural anesthesia were recruited in the study. The patients were sedated with propofol given by TCI, BP, HR, SPO 2 . Bispectral indices were monitored and recorded simultaneously and correlated with Ramsay degree, compared with the effective site concentration (ESC) of propofol given by TCI, and the relationship of BIS and vital signs. Results At the 4th Ramsay degree, ESC and BIS were (1.6±0.16) mg·L -1and 78.50±4.60, respectively, and vital signs were stable. HR, MAP, and SPO 2were significantly different from those at 5th, 6th Ramsay degrees (P<0.01), but they were not different from those at 2th Ramsay degree (P>0.05). Conclusion There is good correlation between BIS and ESC of propofol given by TCI, and BIS can predict the level of sedation. The 4th Ramsay degree is applicable under epidural anesthesia and vital signs are stable and complications are few.