小剂量咪唑安定与曲马多在腹腔镜术后拔管期的应用

Clinical application of low dose midazolam combined with tramadol during extubation after laparoscopic operation

目的：观察小剂量咪唑安定与曲马多在全麻腹腔镜术后拔管期的应用效果.方法：40例 ASA Ⅰ～Ⅱ级在全麻下行腹腔镜手术患者随机分为观察组（A组）和对照组（B组）,观察组静脉注射小剂量咪唑安定0.03～0.04mg/kg, 曲马多0.5～1mg/kg,3～5min后拔管.对照组静脉注射生理盐水10ml后拔管.记录诱导前、给药后2min、拔管时、拔管后5min、10min的呼吸（RR）、血氧饱和度（SPO2）、心率（HR）、血压（BP）的变化值及术后清醒时间,观察拔管期躁动、呛咳等不良反应情况及术后随访对拔管的记忆.结果：A组用药后2min、拔管时、拔管后5min HR、BP明显低于B组（P〈0.01）,RR、SPO2稍有下降,A组清醒时间延长（P〈0.01）,不良反应发生率低于B组（P〈0.05）,遗忘率达100%.结论：全麻腹腔镜术后静脉注射小剂量咪唑安定和曲马多,能达到适宜的镇静镇痛作用,从而有效抑制拔管期的心血管应激反应,减少不良反应,并消除不良记忆.

Objective：To observe the effect of low-dose midazolam with tramadol during extubation after laparoscopic operation. Methods： Forty patients with ASA I - Ⅱ were divided randomly into two groups： group A （observation group,n= 20） and group B （control group, n= 20）. General anesthesia was induced and maintained with midazolam . propofol, remifentangly, vecuronium. Neostigmine and atropine was intervenous injection to antagonismed vecuroni- wn-induced neuromuscular blokade while extubation indication speared after operation. Group A were given low-dose midazolam 0. 03-0. 04mg/kg and tramadol 0. 5- 1mg/kg and extubated after 3-5min. Group B were administrated extubation with 0. 9% NaCl 10ml intervenous inieetion. The changes of different vital signs, RR, heart ratio, blood pressure and blood oxygen saturation were noted before induced, 2min after gave drug, extubation moment and 5min, 10min after extubation. Observed wakening time, agitation rate and amnesia note. Results： Compared to control group ： heart rate and blood pressure of the patients were much lower during gave drug 2min, extubation moment in group A and wakening time was longer. The incidence of agitation were lower significantly. Amnesia ratio of group A was 100%. Conclusion： Low-dose midazolam and tramadol intervenous injection after laparoscopic operation can obtain appropriate effect of analgesia and sedation and prevent cardiovascular response during the period of extubation, decrease side response,and completely eliminate the uncomfortable memory.