摘要
目的 :术后病人应用咪唑安定和芬太尼硬膜外自控镇痛 (PCEA) ,以探讨其复合用药镇痛效果、副作用及其作用机理。方法 :43例ASAⅠ～Ⅱ级中下腹部手术病人 ,硬膜外导管分别留置于L1～ 2 和T12 ～L1椎间隙 ,2 %利多卡因维持术中麻醉 ,根据需要加用氟 /芬合剂 1/ 2单位。将上述病人随机分成三组 :0 12 5 %布比卡因 + 0 0 135 %咪唑安定 (BM组 ,14例 ) ;0 12 5 %布比卡因 + 0 0 0 0 4%芬太尼 (BF组 ,15例 ) ;0 12 5 %布吡卡因 + 0 0 0 6 75 %咪唑安定 +0 0 0 0 2 %芬太尼 (BFM组 ,14例 )。当患者术后视觉模拟疼痛评分 (VAS) >5 0分时 ,开始镇痛。并于 2 4小时内分别观察下列指标 :心率、血压、呼吸频率、VAS、镇静评分 (SS)、PrineHenry评分 (PHS)、以及恶心呕吐、瘙痒、排气时间延长等副作用 ;并记录三组病人 2 4小时的用药量。结果 :血压、心率及呼吸频率在三组病人中差异无显著意义 ,镇静评分 :BM组高于BFM组和BF组 (P <0 0 5 ) ;VAS :BM组 >BF组 >BFM组 (P <0 0 5 ) ;PHS三组病人差异无显著意义。BF组中有 4例病人出现术后恶心呕吐 ,8例病人排气时间延长超过正常范围 2 4小时 ,3例病人出现皮肤瘙痒 ;BFM组有 2例恶心呕吐 ,4例排气时间延长 ;而BM组只有 1例恶心呕吐 ,2例排气时间延长。
Objective:To study the postoperative effects,side effects and the mechanisms of midazolam combined with fentanyl given via a patient controlled analgesia device during epidural anesthesia.Methods:43 subjects,ASAⅠ Ⅱ, were scheduled for mid lower abdominal surgery.Epidural catheter was kept in the T 12 L 1 or L 1 2 intervertibral space for postoperative analgesia.During the operation,2% lidocaine was administered.The patients were randomly divided into three groups with 15 cases each:0 125% bupivacaine+0 0135% midazolam (groupBM);0 125%bupivacaine+0 0004% fentanyl(groupBF) and 0 125%bupivacaine +0 00765%mida zolam +0 0002% fentanyl(group BFM).The postoperative analgesia started when the visual analog scale(VAS) was higher than 50.The following data were recorded in postoperative 24 hours:heart rate(HR),blood pressure(BP),respiration rate(RR);VAS,seeation score(SS),Prine Henry Score(PHS);and the postoperative nausea and vomiting (PONV),pruritus,delayed exsufflation and bupivacaine consumption of postoperative 24 hours.Results:No statistical differences were found in HR,BP and RR among three groups;SS in group BM was higher than that in group BFM and group BF( P< 0 05).PHS among the three groups was not statistically different.The bupivacaine consumption in postoperative 24 hours showed a sequence of group BM>group BF>group BFM( P< 0 05).Conclusion:Midazolam combined with fentanyl is a more effective and safer analgesic regime for postoperative patient controlled epidural analgesia.
出处
《临床麻醉学杂志》
CAS
CSCD
2000年第8期377-379,共3页
Journal of Clinical Anesthesiology
