咪达唑仑自控镇静与医师控制镇静的对比研究

Comparison of Midazolam Patient-controlled Sedation with Anesthetist- controlled Sedation

目的研究咪达唑仑自控镇静与医师控制镇静这两种镇静方法的区别。方法选择外科病人120例,随机分为二组,每组60例:P组,咪达唑仑自控镇静组;D组,咪达唑仑常规镇静组。病人术前30min肌肉注射阿托品0.5mg,术前访视病人时讲解PCA泵使用方法。入室后连续监测HR、ECG、BP、SPO2。P组使用Graseby9500型PCA泵,配方:咪达唑仑20mg+生理盐水至100mL。负荷量0.02mg.kg-1,维持速度为0.001mg.kg-1.h-1,PCS为0.02mg.kg-1,锁定时间为3min,PCS给药时间为30s。A组以咪达唑仑使用Graseby3500型微量泵持续输注镇静,负荷量0.02mg.kg-1,维持速度为0.001mg.kg-1.h-1,每隔10min用Ramsay镇静评分评估镇静深度,如达不到或超过理想的镇静深度(Ramsay镇静评分4分),则增加或减少50%的速度,直至达到理想的镇静深度。镇静开始前给病人观看图片3张,术后12h询问病人记忆情况。使用VAS评分评估病人满意度。结果两组病人咪达唑仑用量分别为P组(10±4)mg,A组(9±3)mg,两组比较无统计学意义(P>0.05)。两组病人术后均有良好的顺行性遗忘,遗忘率P组87%,A组84%,两组比较无统计学意义(P>0.05)。满意度P组(89±6)、A组(71±8),两组比较有显著的统计学意义(P<0.01)。结论咪达唑仑自控镇静与常规镇静这两种镇静方法均有良好的顺行性遗忘作用,病人更满意自控镇静。

Objective To study the anterograde amnesia caused by midazolam which was used by patientcontrolled sedation and anesthetist-controlled sedation. Methods 120 patients in surgical patients were divided randomly into two groups,60 patients in each.P group：patient-controlled sedation with midazolam;A group：anesthetistcontrolled sedation with midazolam.Atropine 0.5mg was injected 30rain before operation,explaining the correct application of PCA pump to patients when we interview them.HR, ECG, BP, SPO2 were monitored during anesthesia.P group：midazolam 20mg＋normal saline（NS） to 100mL,midazolam loding dose 0.02mg·kg^-1,continous rates 0.001mg· kg^-1· h^-1 PCS 0.02mg·kg^-1,iockout time 3min,PCS rates 30 seconds.A group：midazolam loding dose 0.02 mL·kg^-1,continue rate 0.001mg·kg^-1· h^-1,Ramsay sedation score was used to evaluate the sedative depth every 10 minutes,appropriate sedative depth（Ramsay sedation score 4） kept by adjusting the infusion rate.Showing patients three pictures before sedation started,and checking patient memory at 12h after operation.Accessing the patient＇s satisfaction degree by VAS score.Results The amount ofmidazolam was a little higher in P group（10±4）mg,than that in A group（9±3） mg, but there was no significant difference （P〉0.05）.Postoperative anterograde amnesia existed in both two groups, memorability has no significant difference between two groups（P〉0.05）,and there was a statistic difference between two groups [P group（89 ± 6） and A group （71±8）] in patient satisfaction degree （P〈0.001）. Conclusion Satisfactory anterograde amnesia occurred in both PCS group and ACS group.Patient preferred PCS.