异丙酚复合迷达唑仑对妇科腹腔镜手术病人苏醒影响

EFFECT OF PROPOFOL COMBINED WITH MIDAZOLAM ON THE ANALEPSIA IN GYNECOLGICAL LAPAROSCOPIC SURGERY

目的探讨在相同麻醉镇静深度时,异丙酚复合不同剂量的迷达唑仑对不同麻醉维持时间的妇科腹腔镜手术病人苏醒的影响。方法ASAⅠ～Ⅱ级、年龄20～50岁拟行妇科腹腔镜手术病人60例,随机分为3组。P组以异丙酚靶控输注(TCI)及芬太尼分次静脉注射麻醉诱导及维持,维库溴铵维持肌松;M1组和M2组在P组基础上,诱导时静脉注射迷达唑仑0.05mg.kg-1后,分别复合0.04或0.08mg.kg-1.h-1剂量的迷达唑仑持续静脉注射。根据麻醉维持时间分为Pa、M1a、M2a(麻醉时间≤60min)和Pb、M1b、M2b(麻醉时间>60min)6组。术中调整异丙酚靶浓度维持BIS于45～55之间。记录麻醉苏醒时间(停止异丙酚TCI至呼之睁眼)及苏醒后5minOAA/S评分。结果M2b组苏醒时间较Pa组明显延长(F=3.051,q=5.31,P<0.05),其余各组间比较无差异(P>0.05);苏醒后OAA/S评分P组明显高于M1、M2组(F=4.849,q=5.56～12.15,P<0.05),M2b组明显低于其余各组(q=4.04～12.15,P<0.05)。结论妇科腹腔镜手术中,当麻醉维持时间≤1h时,以0.08mg.kg-1.h-1剂量的迷达唑仑复合异丙酚TCI麻醉不影响麻醉后病人苏醒时间和苏醒质量;但当麻醉维持时间>1h时,复合的迷达唑仑剂量应减至0.04mg.kg-1.h-1,以避免苏醒延迟及苏醒质量的降低。

Objective To investigate the effects different-dose Propofol combined with midazolam anesthesia on analepsia in gynecological patients undergoing laparoscopic surgery under same depth of anesthesia. Methods Sixty ASA physical status Ⅰ-Ⅱ female patients, aged 20- 50 years, scheduled for laparoscopic gynecologic surgery were equally randomized to three groups. One received Propofol, Fentanil and Vecuronium Bromide （group P）. Others combined with Midazolam either dose 0.04 mg·kg^-1·h^-1 （group M1） or 0.08 mg·kg^-1·h^-1 （group M2） after iv. Of Midazolam 0.05 mg·kg^-1 at anesthesia in duction. They were then divided into six subgroups, according to the anesthesia maintaining time, as Px, M1a, and M2a groups （an-esthesia maintaining time ≤60 min） and Pb, M1b and M2b groups （anesthesia maintaining time 〉 60 min）. During operation, Propofol concentration was adjusted to maintain BIS value between 45 and 50. The awakening time and OAA/S score of 5 rain after analepsia were recorded. Results The post-anesthesia recovery time was significantly longer in group M2b than that in group Pa （F= 3. 051,q= 5.31,P〈0.05）. And there was no significant difference among other groups （P〉0.05）. The OAA/S scores in groups Pa, and Pb were significantly higher than groups M1a, M2a, M1b and M2b（F=4. 849 ,q=5.56-12. 15,P〈0.05）, while the score in group M2b was obviously lower than the other groups （q=4.04-12.15,P〈0.05）. Conclusion In the laparoscopic gynecologic surgery, Propofol anesthesia combined with a dose of 0.08 mg·kg^-1·h^-1 of Midazolam will not affect the recovery time and quality if anesthesia maintaining time is shorter than 60 min. But if anesthesia maintaining time is longer than 60 rain, the dose of Midazolam should be reduced to 0.04 mg·kg^-1·h^-1to prevent from prolong recovery time and decreasing recovery quality.