舒芬太尼复合咪达唑仑辅助椎管内麻醉效果评价

Assessment of efficacy of sufentanil and midazolam in intravertebral anesthesia

目的探讨等效剂量舒芬太尼与芬太尼复合咪达唑仑辅助椎管内麻醉对镇静、呼吸、循环的影响。方法 80例择期椎管内麻醉下行下腹部及下肢手术的患者,随机分成F组(芬太尼组,40例)和S组(舒芬太尼组,40例)。观察两组患者给药后的RF、SpO2、EtCO2、HR、MBP变化,SpO2≤90%的病例数、镇静评分,以及是否出现术中遗忘。结果给药后5 min(T1)时,F组HR低于S组(P<0.05);F组中的RF在给药后5 min(T1)、10 min(T2)、15 min(T3)时较S组慢(P<0.05),SpO2在给药后5 min(T1)、10 min(T2)时低于S组(P<0.05),EtCO2给药后5 min(T1)、10 min(T2)、15 min(T3)时较S组高(P<0.05);F组镇静评分在给药后30 min(T5)、45 min(T6)时较S组低(P<0.05);S组术中遗忘的例数多于F组(P<0.05)。结论舒芬太尼-咪达唑仑辅助椎管内麻醉与芬太尼-咪达唑仑比较,对呼吸及心率抑制较轻,镇静时间长,遗忘作用强,为椎管内麻醉中较为理想的镇静镇痛辅助药。

Objective To discuss the influence of equivalent dose of sufentanil and fentanyl combined with midazolam for intravertebral anesthesia on sedation,respiration system and circulation system.Methods Eighty patients aged 35~55 years undergoing abdominal and lower limb surgery under intravertebral anesthesia were randomly divided into two groups：group F（fentanyl group,n=40）and group S（sufentanil group,n=40）.The changes of respiratory frequency（RF）,pulse oximetry（SpO2）,end-tidal CO2（EtCO2）,heart rates（HR）and mean arterial pressure（MBP）of the two groups were observed,and the number of patients whose SpO2≤90%,score of sedation and presence of intraoperative forgotten was recorded and contrasted.Results At 5 min after administration（T1）,there was significant difference in HR between group F and group S（P0.05）.In group F,the RF was slower than that of group S at 5 min（T1）,10 min（T2）and 15 min（T3）after administration（P0.05）;and the SpO2 was also lower than that of group S at 5 min（T1）and 10 min（T2）after administration（P0.05）;and the EtCO2 was higher than that of group S at 5 min（T1）,10 min（T2）and 15min（T3）after administration（P0.05）.Compared with group F,the score of sedation in group S was lower at 30 min（T5）and 45 min（T6）after administration（P0.05）.Group S had a lower incidence of intraoperative forgotten than group F（P0.05）.Conclusion Sufentanil-Midazolam has lighter breathing and heart beat inhibition than fentanyl-midazolam,and the sedative time is longer with stronger intraoperative forgetting effect.It is a ideal auxiliary medicine for intravertebral anesthesia.