摘要
目的:探讨不同剂量咪唑安定应用于硬膜外麻醉下行骨科手术中的镇静、消除病人的围术期不良记忆(顺行性遗忘)的效果及安全性。方法:120例患者随机分成四组,各组入室后分别静脉给眯唑安定0.1 mg·kg 1(Ⅰ组)、0.075 mg·kg 1(Ⅱ组)、0.05 mg·kg'(Ⅲ组)和NS 3 mL(对照组,Ⅳ组),术中以微量注射泵持续输注眯唑安定至手术结束前20min。记录基础值及使用咪唑安定后5 min、15 min、30 min及手术结束时的平均动脉压(MAP)、心率(HR)、呼吸(R)、指脉搏氧饱和度(SpO2);观察镇静程度,遗忘率及术中、术后烦躁,恶心、呕吐,头晕及幻梦等不良反应。结果:I组静注咪唑安定后5 min、15 minMAP较基础值明显下降(P<0.05),其余各组MAP、HR、R、SpO2与基础值比较虽有变化但无显著差异(p>0.05)。镇静程度3级及以上Ⅰ组29例、Ⅱ组26例、Ⅲ组19例均较Ⅳ组0例有显著差异(P<0.05),Ⅰ、Ⅱ组间镇静程度无显著差异;但较Ⅲ组有显著差异(P<0.05);Ⅰ组遗忘率96.7%、Ⅱ组遗忘率93.3%、Ⅲ组遗忘率76.7%明显高于Ⅳ组无遗忘(P<0.05). Ⅰ、Ⅱ组间遗忘率无显著差异但明显高于Ⅲ组(P<0.05);镇静和遗忘效果与剂量呈正相关性。使用咪唑安定病人有8例出现烦躁不安,不听指令,术后出现恶心、呕吐3例,头晕3例。结论:咪唑安定应用于硬膜外麻醉下行骨科手?
Objective: To investigate the effect and safety of different dose midazolam on anti-anxiety,sedation and anter grade amnesia of patients undergoing orthopaedic surgery with epidural block. Methods: 120 patients were randomly divided into four groups which received intravenous infusion of midazolam 0.1mg·kg1(group Ⅰ ,n = 30),0.075 mg·kg 1(group Ⅱ n=30),0. 05 mg·kg1 (group Ⅲ n =30) or saline 3mL (group Ⅳ,n = 30) respectively and followed by a continuous infusion during surgery until 20 minutes before the end of operation. MBP,HR,RR and SpO2 were recorded respectively before administration. 5 mins 15 mins and 30 mins after administration. Degree of sedation,incidence of amnesia and the side effects such as agitation, nausea and vomiting,dizzy,fantasy were also observed. Results:MAP in group I decreased obviously 5 mins and 15 mins after midazolam was given ( P<0. 05) ,while the variety of MAP、 HR、 R、SpO2 in other groups had no significant differences (P> 0. 05). There were 29 patients whose sedation grade were above 3 in group Ⅰ . while 26 in group Ⅱ and 19 in group Ⅲ, there was significant difference between group Ⅰ-Ⅱ and Ⅳ group (P<0. 05),there were significant differences between group Ⅰ ,Ⅱ and group Ⅲ (P<0. 05) while there were no significant differences between group Ⅰ and Ⅱ . The amnesia incidences was 96.7% in group Ⅰ . while 93.3% in group Ⅱ and 76. 7% in group Ⅲ, there was singificant difference between group Ⅰ-Ⅱ and group Ⅳ also (P<0. 05) ,there were great significant differenc es between group Ⅰ . Ⅱ and group Ⅲ (P<0.05)while there were no significant differences between group Ⅰ and Ⅱ, there were correlation between sedation grade and amnesia. Agitation occurred in 8 patients, nausea and vomiting occurred in 3 patients and dizzy in 3 patients after the administration of midazolam. Conclusion:The application of midazolam is effective on anti-axiety, sedation and anterograde amnesia in orthopaedic surgery with epidural block and the dose of 0.075 mg ·kg-1 is more effective and safe.
出处
《中国临床医学》
北大核心
2005年第1期150-152,共3页
Chinese Journal of Clinical Medicine
