不同剂量咪芬合剂用于阑尾切除术镇静的临床研究

Clinical study of the sedative effect of different dosage regimens of midazolam and fentanyl during appendectomy

目的观察不同剂量的咪芬合剂用于阑尾切除术镇静对患者呼吸、循环及意识的影响。方法 40例美国麻醉师协会(ASA)分级Ⅰ～Ⅱ级拟于联合麻醉下行阑尾切除术患者,随机分到不同剂量的咪芬合剂组和生理盐水对照组,每组10例,观察记录给药前及给药后1、2、3、5、10、15 min患者的血压、心率、呼吸频率、氧饱和度(SpO2)、警觉/镇静(OAA/S)评分等指标。结果各组患者心率随芬太尼剂量增大而减慢(P<0.05);在给咪芬合剂后2～10 min内,患者呼吸频率、SpO2和OAA/S评分随咪芬合剂剂量增大而降低(P<0.05),各组50岁以上的患者发生SpO2降低的比率大于50岁以下的患者。结论硬膜外麻醉下给予咪芬合剂镇静后2～10 min内可使患者呼吸、循环功能受到一定影响,其程度与咪芬合剂的剂量和患者的年龄相关。

Objective This study observe the changes of circulation,respiration and conscious state of the patients under epidural anesthesia for appendectomy after receiving midazolam and fentanyl at different dosages.Methods Forty ASAⅠ～Ⅱ patients undergoing appendectomy under epidural anesthesia were divided into 4 groups with 10 patients in each group.Patients in 3 groups received midazolam and fentanyl at different dosages for sedation and patients in control group received normal saline（NS）.Blood pressure,heart rate,respiratory rate,SpO2 and OAA/S score were recorded before and 1,2,3,5,10,15 minute after received sedatives or NS administration.The number of respiratory depression in each group was also recorded.Results Heart rate decreased with the increase of fentanyl administration（P0.05）.Respiratory rate,SpO2 and OAA/S score of the patients decreased（P0.05）.2~10 minutes after received increased dosage of midazolam and fentanyl.BIS and OAA/S score decreased more obvious in older patients（≥50y）.Conclusion Midazolam and fentanyl administration can affect the circulation and respiration of the patients and the severity is positively related with the dosage of the drugs and the age of the patients under epidural anesthesia.