不同剂量咪达唑仑在全麻中对患者应激反应的影响

The Effects of Different Doses of Midazolam on the Stress in General Anesthesia Patients

目的:探讨全麻术中不同剂量的咪达唑仑联合丙泊酚对患者应激反应的影响,为临床安全合理用药提供依据。方法:全麻下行择期上腹部手术患者60例,ASAI～Ⅱ级,随机分为M1组(咪达唑仑0.05mg/kg)、M2组(咪达唑仑0.1mg/kg)、M3组(咪达唑仑0.15mg/kg),每组20例,手术时间约为2.5小时。所有患者记录入室(T0)、麻醉诱导后3min(T1)、给药5min(T2)、切皮后2min(T3)、术中探查(T4)、术后清醒(T5)各时间点的HR、BP、MAP、HRV、BIS并测定血糖。结果:①三组患者给药后各时间点HR、SBP、DBP、MAP与给药前比较有统计学意义。HR在T1、T2、T3、T4时刻M1组与M2组、M3组比较有统计学意义,M2组与M3组比较无统计学意义;SBP、DBP、MAP在T1、T2时刻M1组与M2组、M3组比较有统计学意义,M2组与M3组比较无显著差异。②BIS、GLU给药后各时间点的数值与给药前比较有统计学意义。BIS在T1时刻M1组与M2组、M3组比较有统计学意义,M2组、M3组比较无显著差异。GLU在T5时刻M1组与M3组有统计学意义。HRV变化不明显。结论:临床剂量的咪达唑仑有抗应激作用。剂量增大可抑制应激反应,其剂量为0.1mg/kg时各指标变化相对平稳。

Objective ：To explore the effects of different doses of midazolam combined with propofol on the stress response of patients in general anesthesia for providing the basis for administration in clinical security. Methods： Sixty patients （ASA I - Ⅱ ） scheduled for selective upper abdominal surgery with general anesthesia were randomly divided into three groups, M1 （midazolam 0.05 mg / kg）, M2 （midazolam 0.1 mg / kg） and M3 （ midazolam 0.15 mg / kg） groups, each with 20 cases. 30 minutes after the incision, all patients＇ HR, BP, MAP, HRV, BIS were recorded when patients entered the operating room （TO）, 3 min after induction of anesthesia （T1）, 5 min after administration （T2）, 2 min after skin incision （T3）, implicit stimulation （T4）, and after sober （T5） .Meanwhile , measured glucose concentrations . Results： （1） HR, SBP, DBP, MAP, after administration compared with previous administration had significant differences. At T1, T2, T3 and T4, the results of HR in M1 compared with M2 and M3 had significant differences. M2 compared with M3 had no significant differences. At T1 and T2, the results of SBP, DBP, MAP in M1 compared with M2 and M3 had significant differences. M2 compared with M3 had no significant differences. （2）There were statistical significant differences in BIS and GLUafter administration when compared with previous administration. BIS at T1 moment compared MI with M2 and M3 had significant differences, group 2 and 3 were meaningless. GLU at T5, MI compared with M3 had significant differences. HRV did not change significantly. Conclusions： Clinical dose of midazolam can eliminated the anti-stress effect. The higher dose can inhibit the stress response, when the dosage of midazotam is 0.1 mg / kg, the index are relative stability.