咪达唑仑复合舒芬太尼MAC技术在局麻下小切口开胸肺活检中的应用

Application of MAC by Midazolam Combined with Sufentanil in Minithoracotomy Biopsy under Local Anesthesia

目的:探讨以咪达唑仑复合舒芬太尼实施麻醉下监护(Monitored Anesithesic Care,MAC)技术应用于小切口开胸肺活检术中的有效性和安全性。方法:对本院20例局麻下行小切口开胸肺活检手术的患者给予咪达唑仑和舒芬太尼,术中连续监测心电图(ECG)、有创动脉血压(IBP)、脉搏血氧饱和度(SpO2)、呼吸频率(RR)、动脉血气分析指标(PH值、PaO2、PaCO2),录得Ramsay、VAS评分,记录患者开胸前、开胸后3 min、开胸后10 min和关胸后10 min的SBP、DBP、HR、SpO2、RR及动脉血气分析指标。结果:开胸前、开胸后3 min、开胸后10 min和关胸后10 min的SBP、DBP、HR、SpO2、RR及动脉血气分析指标的PH值、PaCO2比较无统计学意义(P>0.05)。结论:咪达唑仑复合舒芬太尼MAC技术应用于局麻下小切口开胸肺活检术,镇静镇痛效果确切,安全,是提高医疗质量的有效措施。

Objective To investigate the effect and safety of monitored anesthesia care （MAC） by midazolam combined with sufentanil in minithoracotomy biopsy under local anesthesia. Methods： In a study at our hospital, 20 patients included, MAC was performed using midazolam and sufentanil in minithoracotomy biopsy under local anesthesia. We measured vital signs, including SBP, DBP, HR, SpO2 and RR. Arterial blood was also sampled and analyzed for PH, PaO2 and PaCO2. Sadation levels were measured with the Ramsay sedation scale, and pain intensity was measured with the VAS. Vital signs and arterial blood gas analysis were recorded at time before opening thoracic cavity （T1）, 3 minutes after opening thoracic cavity （T2）, 10 minutes after opening thoracic cavity （T3） and 10 minutes after closing thoracic cavity （T4）. Results：There was no statistically significant difference in the values of vital signs（P 〉0.05） between TI, T2,T3 and T4. No significant changes between T1, T2,T3 and T4 were observed in PH and PaCO2 （ P 〉0.05 ） . Conclusion： The application of MAC by midazolam combined with sufentanil in minithoracotomy biopsy under local anesthesia is safe, effective, feasible and comfortable.