咪达唑仑和芬太尼用于腰硬联合麻醉镇静的临床观察

【摘要】 目的：观察不同剂量咪达唑仑加芬太尼用于腰硬联合麻醉镇静的临床效果。方法：80例 ASAⅠ～Ⅱ级下腹部手术患者随机分为I、II、III、IV 4组，分别采用0.02、0.04、0.06和0.08 mg/kg咪达唑仑辅助芬太尼 0.001 mg/kg进行腰硬联合麻醉镇静，以改良警觉/镇静评分法(OAA/S)记录给药不同时间患者的镇静程度、遗忘程度，观察术中患者生命体征的变化。结果：给药后5minⅠ组、Ⅱ组OAA/S评分明显高于Ⅲ组、Ⅳ组(P0.05)，给药后 10、30、60 minⅠ组 OAA/S 评分明显高于Ⅱ、Ⅲ、Ⅳ组(P0.05～0.01)。给药后 30 minⅡ、Ⅲ、Ⅳ组遗忘作用均优于Ⅰ组，Ⅲ、Ⅳ组优于Ⅱ组(P0.05)，给药后 120 min Ⅲ、Ⅳ组遗忘作用优于Ⅰ、Ⅱ组(P0.05)。镇静、遗忘程度依次为Ⅳ组Ⅲ组Ⅱ组Ⅰ组。4组各生命体征指标差异无统计学意义(P0.05)，均未发生严重的血压下降，Ⅳ组呼吸抑制发生率最高。结论：0.04～0.06 mg/kg 咪达唑仑辅助0.001 mg/kg芬太尼较适用于腰硬联合麻醉的镇静、遗忘剂量。

【关键词】 咪达唑仑; 芬太尼; 镇静;遗忘。

[ABSTRACT] Objective: To determine the effects of different doses of midazolam and fentanyl on combined spinalepidural anesthesia and sedation. Methods: Eighty patients undergoing grade ASAⅠ～Ⅱlower abdominal surgery were divided randomly into 4 groups: group I, II, III and IV; 0.02,0.04,0.06 and 0.08 mg / kg midazolam and 0.001 mg / kg fentanyl were used respectively for combined spinalepidural anesthesia and sedation, and degrees of sedation, oblivion were recorded at different time of drug administration according to modified Observer‘s Assessment of Alertness / Sedation Scale (OAA / S) , with observation of changes of vital signs. Results: OAA / S scores in groupⅠandⅡ5min after administration were significantly higher than that in group Ⅲ and Ⅳ(P0.05), OAA / S score in groupⅠ10,30,60 min after administration was significantly higher than that in groupⅡ,Ⅲ,Ⅳ(P0.05 ～ 0.01). 30 min after administration, the forgeting degrees in groupⅡ, Ⅲ, Ⅳ were all better than that in groupⅠ, and Ⅲ, Ⅳgroup were better than that in groupⅡ (P0.05); 120 min after administration, the forgeting degrees in group Ⅲ, Ⅳ were better than that in groupⅠ, Ⅱ( P0.05). The order of degrees of sedation and oblivion was group Ⅳ group Ⅲ groupⅡ groupⅠ. Indicators of the vital signs between the 4 groups were no significant differences (P0.05), no serious low blood pressure occurred, respiratory depression occurred more in group Ⅳ. Conclusion: 0.04 ～ 0.06 mg / kg midazolam combined with 0.001 mg / kg fentanyl is the appropriate dosage for sedation and oblivion of combined spinalepidural anesthesia.

[KEY WORDS] Midazolam; Fentanyl; Sedation; Oblivion。

下腹部手术常选择腰硬联合麻醉，术中患者多为清醒状态，容易紧张、恐惧，需给予辅助镇痛、镇静药物。咪达唑仑和芬太尼联合应用具有稳定心血管系统功能、镇静遗忘作用强、抗术中内脏神经牵拉反应效果好等特点[1]。本研究对不同剂量咪达唑仑加芬太尼用于腰硬联合麻醉镇静的临床效果进行了观察，现报道如下。

1 临床资料。

1.1 一般资料。

随机选择80例择期下腹部手术患者，年龄 18～55岁，体重 43～68 kg，ASAⅠ～Ⅱ级，无长期服用镇静药史，无呼吸、循环及精神、神经系统疾病史。80例患者随机分为I～IV组，4组患者年龄、性别、体重、心率、平均动脉压、血氧饱和度经检验差异无统计学意义(P0.05)，具有可比性。

1.2 方法。

I、II、III、IV 4组分别采用0.02、0.04、0.06和0.08 mg/kg咪达唑仑辅助芬太尼 0.001 mg/kg进行腰硬联合麻醉镇静，所有患者术前禁食8 h，入室后开放上肢静脉，均采用腰硬联合麻醉，经L3～L4间隙穿刺，蛛网膜下腔注入0.5%盐酸布比卡因2～3 mL，注毕后向头侧置入硬膜外导管3 cm，效果欠佳或手术时间较长者硬膜外追注2%盐酸利多卡因,麻醉成功并测定麻醉效果后面罩吸氧 3～ 4 mL/min至术毕，观察术中不良反应，如体动、恶心、呕吐、呃逆等，并给予相应处理。以改良警觉/镇静评分法(OAA/S)记录给药不同时间患者的镇静程度、遗忘程度，观察术中患者生命体征的变化。