雷米芬太尼与咪唑安定辅助局部麻醉镇痛镇静的输注方式探讨

Optimal regimen of remifentanil-midazolam for analgesia and sedation during minor surgery under local anesthesia

目的探讨雷米芬太尼和咪唑安定辅助局部麻醉手术镇静镇痛的输注方式。方法172例局麻择期手术成年患者随机分为R0.0375、R0.05、R0.0625、R0.075四组,分别输注雷米芬太尼0.0375、0.05、0.0625和0.075μg·kg-1.min-1,并接受咪唑安定0.025mg·kg-1.h-1输注。如果术中患者疼痛的11点数字评分(NRS)>3,单次注射雷米芬太尼10μg;如果术中患者改良的OAA/S镇静评分<2,单次注射咪唑安定0.5mg。结果与R0.0375、R0.05组相比,R0.0625、R0.075组患者因呼吸抑制需减慢或暂停雷米芬太尼输注的发生率显著增加(P<0.05)。无一例患者发生过度镇静。术中知晓的发生率与雷米芬太尼的持续输注剂量成反比,但R0.05、R0.0625、R0.075三组间差异无统计学意义。结论在给予负荷剂量的咪唑安定0.025mg/kg和雷米芬太尼0.5μg/kg后,最好以咪唑安定0.025mg·kg-1.h-1和雷米芬太尼0.05μg·kg-1.min-1的剂量输注,然后根据镇静水平或疼痛程度给予单次剂量的咪唑安定0.5mg或单次剂量的雷米芬太尼10μg。

Objective To explore an optimal regimen of remifentanil-midazolam for analgesia and sedation during minor surgery under local anesthesia. Methods One hundred and seventy-two adult patients scheduled for elective surgery under local anesthesia were randomly assigned to four groups of group R0. 0375 ,R0.05 , R0.0625 and D recived remifentanil 0. 0375, 0.05, 0. 0625 and 0. 075μg·kg^-1·min^-1, respectively. All patients were sedated with midazolam 0. 025 mg·kg^-1·h^-1. During the operation,if the pain score was greater than 3 on the 11-point numeric rating scale（NRS）, a bolus of remifentanil 10 μg was injected, and if the sedation score was less than 2 on the reversed Observer＇s Assessment of Alertness/Sedation scale（OAA/S）, a bolus of midazolam 0. 5 mg was injected. Results The incidences of decrease or stop of remifentanil infusion owing to respiratory depression were higher in group R0.0425 and group R0.075 than those in group R0.0375 and group R0.05 （P〈0.05）. Oversedation did not occur in any patient. Awareness decreased with the increase of the infusion rate of remifentanil, but there was no statistical difference among group R0.05, R0.0625 and R0.075. Conclusion It is suggested that, on the basis of loading injection of remifentanil 0.5 /＊g/kg and midazolam 0. 025 mg/kg,midazolam and remifentanil are infused better at the rate of 0. 025 mg·kg^-1·h^-1 and 0.05 μg·kg^-1·min^-1, respectively. A bolus of midazolam 0. 5 mg or remifentanil 10 μg is supplemented according to sedative level or pain score.