咪达唑仑的顺性遗忘作用临床观察

Clinical Study of Amnesia of Midazolam

目的观察咪达唑仑(MDZ)辅助局麻时的顺性遗忘作用。方法ASAI～II级择期在硬膜外阻滞或臂丛阻滞下手术患者100例,随机分为A,B两组,每组50例,麻醉效果确定后,A组患者静注MDZ0.04mg/kg,切皮前两组患者均静滴芬太尼0.1mg和氟哌利多5mg,用OAA/S评分标准评定镇静深度,并记录。对未达3分者,A组患者术中追加MDZ0.02mg/kg,维持OAA/S评分2～3分,术后随访患者的遗忘情况。结果随着OAA/S评分由4～2分,镇静深度逐渐加深,遗忘率逐渐上升,A组遗忘率显著高于B组(P<0.01)。结论MDZ有良好的顺性遗忘作用,镇静深度可控制在OAA/S评分2～3分。

Objective To observe the amnesia of midazolam under regional anesthesia. Methods 100 ASA I^II patients scheduled for operation under regional anesthesia were divided into group A and group B,each group 50 cases. Patients with abnormal heart,pulmonary, liver and kidney functions or habitually taking benzodiazepine were excluded. The patients were premediated with luminal 0.l mg and atropine 0.5mg. When the level of block was fixed, midazolam 0.04mg/kg was given intravenously (IV) in group A, fentanyl 0.l mg and droperidol 5mg were given IV before operation, midazolam 0.02mg/kg was given to maintain adequate sedation during operation in group A and maitain OAA/S score 2~3. Level of sedation was assessed using observer's estimation of alertness/sedation(OAA/S) scale. Postoperative interview was carried out to determine patients amnesia. Results As the depth of sedation deepened OAA/S score 4~2,amnesia increased. The amnesia of group A was significantly higher than that of group B(P<0.01). Conclusion Adding midazolam can increase amnesic effect. OAA/S score 2~3 is the appropriate level of sedation during regional anesthesia.