舒芬太尼-咪达唑仑辅助硬膜外麻醉对内脏牵拉反应及镇静遗忘的影响

Effects of epidural anesthesia combined with sufentanii plus midazolam on visceral traction response, sedation and amnesia

目的:观察舒芬太尼-咪达唑仑辅助硬膜外麻醉对内脏牵拉反应及镇静遗忘的影响。方法:50例硬膜外麻醉行腹部手术患者,随机分成两组,每组25例。阻滞完善后,切皮前5～10 min,试验组负荷剂量舒芬太尼0．1μg·kg-1+咪达唑仑20μg·kg-1后,微泵持续静注舒芬太尼0．3～0．15μg·kg-1·h-1+咪达唑仑60～30μg·kg-1·h-1至手术结束;对照组单次静注哌替啶1 mg·kg-1+氟哌利多0．05 mg·kg-1。观察两组心率(HR)、无创收缩压(SBP)、舒张压(DBP)、脉搏血氧饱和度(SpO2),评估防治内脏牵拉反应效果及镇静遗忘作用。结果:试验组HR,SBP,DBP,SpO2平稳;在防治内脏牵拉反应效果方面,试验组和对照组有效率分别为96％和72％,两组警觉／镇静(OAA／S)评分2～3分者分别为92％和68％,完全遗忘作用分别为88％和24％,试验组均优于对照组(P<0．05)。结论:负荷剂量后微泵持续静注舒芬太尼-咪达唑仑辅助硬膜外麻醉防治内脏牵拉反应效果佳,镇静遗忘作用强。

Objective：To assess the effects of epidural anesthesia combined with sufentanil plus midazolam on visceral traction response, sedation and amnesia in abdominal surgeries. Methods： Fifty ASA Ⅰ～Ⅱ patients undergoing abdominal surgeries under epidural anesthesia were equally randomized to assign to one of two treatment groups. After epidural blockade and before the incision about 5 ～ 10 minutes ahead, one group （group Ⅰ ） was injected with a loading dose of sufentanil 0. 1μg·kg^-1 and midazolam 20μg·kg^-1, and then continuously infused with a maintenance dose of sufentanil 0. 3 ～ 0. 15μg·kg^-1·h^-1 and midazolam 60 ～ 30μg·kg^-1·h^-1 in aids of micro-infusion pump （ Graseby 3 500 Anesthesia Pump）until the surgery was over; the other group （ group Ⅱ） was injected with a single dose of pethidine 1 mg·kg^-1 and droperidol 0.05 mg·kg^-1. The primary objective of the treatment was to assess the prevention of the visceral traction response, sedation and amnesia in both groups. The other objectives included the changes of heart rate, systolic pressure, diastolic pressure and SpO 2 pre-and post-treatment. Results： The patients in group Ⅰ and group Ⅱ experienced the prevention rate of visceral traction response of 96% vs. 72% , the OAA/S score （2 ～3 scores） of 92% vs. 68% and amnesia of 88% vs. 24% （P 〈 0.05）. Compared with the group Ⅱ, the heart rate, systolic and diastolic pressure and SpO2 were steady in the group Ⅰ. Conclusion ： Combination of epidural anesthesia with sufentanil plus midazolam showed the significant prevention of visceral traction response, sedation and amnesia in abdominal surgeries.