镇静剂量咪唑安定预防全凭静脉麻醉术中知晓的临床观察

Low-dose midazolam for the prevention of awareness during total intravenous anesthesia and recovery from anesthesia clinical observation

目的探讨镇静剂量咪唑安定用于预防全凭静脉麻醉术中知晓及对术后恢复质量的影响。方法选择90例择期手术的全麻患者,ASAⅠ-Ⅱ级,随机分成2组：咪唑安定组（Ⅰ组）、对照组（Ⅱ组）。Ⅰ组诱导时给予咪唑安定0.05mg/kg、芬太尼0.004mg/kg、异丙酚1.5mg/kg及维库溴铵0.1mg/kg;Ⅱ组诱导时未用咪唑安定,其余诱导用药与Ⅰ组相同。术中2组均静脉泵注瑞芬太尼及丙泊酚维持麻醉。结果Ⅱ组患者术中知晓的病例数显著多于Ⅰ组（P〈0.05）。Ⅰ组和Ⅱ组患者的呼吸恢复时间、呼之睁眼时间、拔除气管导管时间及拔出后即刻警觉/镇静（OAA/S）评分差异无显著性（P〉0.05）。结论全麻诱导时应用镇静剂量咪唑安定能抑制术中患者外显性记忆功能,有效预防全凭静脉麻醉的术中知晓,同时不影响全麻后苏醒时间及麻醉后恢复质量。

Objective To study the low-dose midazolam for the prevention of awareness during total intravenous anesthesia and postoperative recovery of quality of clinical effect.Methods 90 cases of elective abdominal surgery for patients,ASA Ⅰ-Ⅱ grade,were randomly divided into 2 groups,midazolam group（Ⅰ group）,propofol group（Ⅱ group）.Ⅰ group given midazolam during induction of 0.05mg/kg,fentanyl 0.2mg,propofol 1.5mg/kg and vecuronium 0.1mg/kg,Ⅱ group without induction with midazolam,induction agents and the remaining group Ⅰ the same.Operation in both groups intravenous infusion of remifentanil and propofol to maintain anesthesia.Results In group Ⅰ and Ⅱ patients breathing recovery time,and respiratory,eye opening,extubation time and pulled out after 5 minutes of Alertness / Sedation（OAA /S） this difference was not statistically significant（P 〉0.05）.Ⅱ patients may be aware of intraoperative awareness and the number of cases significantly higher than in groupⅠ（P〈0.05）.Conclusion anesthesia induction dose of midazolam can inhibit the operation of explicit memory function in patients,effective in preventing systemic intravenous anesthesia,intraoperative awareness,without affecting the recovery time after general anesthesia and the quality of anesthesia recovery.