咪哒唑仑、依托咪酯复合瑞芬太尼在骨科椎体成形手术中的应用

Application of Midazolam and Etomidate Combined with Remifentanli in orhtopaedic vertebral forming operations

目的:观察咪哒唑仑、依托咪酯复合瑞芬太尼在骨科椎体成形手术中的血流动力学变化和麻醉效果。以期改善椎体成形手术中的麻醉管理的质量。方法:60例择期在静脉麻醉下行椎体成形手术的患者,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ,随机分为3组,每组20例。A组局部浸润麻醉组,B组先静脉注射咪哒唑仑0.04μg/kg,在缓慢静脉注射依托咪酯0.2mg/kg至患者意识消失后行局部浸润麻醉,并泵注依托咪酯5～8μg.kg-1.min-1,C组先静脉注射咪哒唑仑0.04μg/kg,在缓慢静脉注射依托咪酯0.2mg/kg至患者意识消失后行局部浸润麻醉,并泵注依托咪酯5～8μg.kg-1.min-1、瑞芬太尼0.1μg.kg-1.min-1。记录麻醉前(T0),局部浸润麻醉时(T1),手术时(T2)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2)。观察血流动力学变化和麻醉效果。结果:与T0比较,A组T1、T2MAP及HR明显升高,B组T1、T2时SPO2下降,T1时HR明显降低。与A组比较,B组、C组T1、T2MAP降低,T1HR降低(P<0.01)。与B组比较,C组T1HR降低,T1、T2SPO2下降(P<0.05)。结论:在局部浸润麻醉的基础上咪哒唑仑、依托咪酯复合瑞芬太尼应用于椎体成形手术麻醉效果良好,安全可行。

Objective： To observe the hemodynamic changes and anesthesia effect of midazolam and etomidate combined with Remifentanil in orthopaedic vertebral forming operations,so as to improve the anesthesia management of vertebral forming operations.Methods： 60 patients undergoing elective vertebral forming surgery in intravenous anesthesia,gradingⅠ-Ⅱ based on ASA,were randomly divided into three groups,each group of 20 cases.Patients of group A were treated with local infiltrating anesthesia.Patients of group B firstly were given midazolam 0.04 μg/kg intravenously,then etomidate 0.2 mg/kg till their consciousness disappeared when local infiltrating anesthesia came into operation.Patients of group C were given midazolam 0.04 μg/kg intravenously and then etomidate 0.2 mg/kg slowly till their consciousness disappeared.Then they were processed with local infiltrating anesthesia,meanwhile pump injected etomidate 5-8 μg·kg-1·min-1 and Remifentanil 0.1 μg·kg-1·min-1.The time before anesthesia（T0）,the time of local infiltrating anesthesia（T1）,the mean arterial pressure（MAP） of the operated（T2）,heart rate（HR）,pulse oxygen saturation（SPO2） were recorded.Hemodynamic changes and anesthesia effect were observed.Results： Compared with T0,MAP and HR in group A increased significantly at T1T2,and SPO2 of group B descended at T1T2,HR descended significantly at T1.Compared with that of group A,MAP of group B and C reduced at T1T2,HR reduced（P0.01）at T1.Compared with those of group B,HR OF group C reduced at T1 and SPO2 reduced（P0.05） at T1T2.Conclusion： On the basis of local infiltrating anesthesia,midazolam and etomidate combined with Remifentanil used in the vertebral forming surgery anaesthesia is effective,safe and feasible.