咪唑安定辅助区域麻醉合适镇静深度及用量的探讨

A clinical investigation of appropriate sedation depth and dosage of midazolam used as an adjuvent during regional anesthesia

目的 探讨咪唑安定辅助区域麻醉的合适镇静深度及用量。方法 150例区域麻醉病 人随机分为A、B、C三组,分别在区域麻醉后,使用咪唑安定至OAA/S镇静深度Ⅱ、Ⅲ、Ⅳ级,观察用 药前后病人血压、心率和脉搏血氧饱和度(SpO2)的变化,对病人术中烦躁的发生率及术中事件的遗 忘率进行评估,并统计各组病人咪唑安定的平均用量。结果 使用咪唑安定后镇静深度与遗忘效果 有一致的变化。A组病人近事遗忘率为84%,B组98%,C组100%。与用药前相比,三组病人的血 压在用药后5、10min有一定程度的下降,下降幅度超过20%的病人A组4例、B组5例、C组5例 C组SpO2在用药后3、5min有明显下降,共有8例降至93%以下,与A、B两组相比,有显著性差异 (P<0.05,P<0.01)。C组烦躁发生率为22%,与A、B两组相比,有显著性差异(P<0.05,P< 0.01)。A、B、C三组达到相应镇静深度咪唑安定用量分别为(0.04±0.02)、(0.06±0.03)、(0.11± 0.05)mg/kg。结论 咪唑安定辅助区域麻醉的合适镇静深度为OAA/SⅢ级,用量为(0.06±0.03) mg/kg。

Objective To investigate appropriate sedation depth and dosage of midazolam used as an adjuvant during regional anesthesia.Methods One hundred and fifty patients undergoing regional anesthesia were randomly divided into three groups. In group A, the patients were sedated at the level of OAA/S Ⅳwith midazolam during regional anesthesia. In group B and C, the sedation depth was kept at the levels of Ⅲ and Ⅱ respectively. The changes of BP,HR and SpO 2 were recorded before and after midazolam. The rate of restlessness and anterograde amnesia was estimated and the average amount of midazolam used was calculated during sedation.Results The sedation depth of midazolam was in accordance with the anterograde amnesia . The rate of amnesia was 84% in group A,which was 98% and 100% in group B and C respectively. BP decreased in certain degree at 5 and 10min after midazolam compared with that before in all three groups. There was a decrease in BP over 20% in 4 cases in group A, in 5 cases in group B and in 5 cases in group C. There was no significant difference in BP drop among three groups. Compared with group B and C SpO 2 droped significantly at 3 and 5 min after midazolam in group C, in which SpO 2 in 8 cases was less than 93%. The restlessness rate in group C was 22%, which was significantly higher than that in group A (2%) and group B (4%). The average amount of midazolam used in group A, B and C was (0.04±0.02),(0.06±0.03) and (0.11±0.05)mg/kg respectively.Conclusion It is suggested that the appropriate sedation depth for the patients under regional anesthesia is OAA/S Ⅲ, and the average dosage of midazolam for that is (0.06±0.03)mg/kg.