咪唑安定复合异丙酚镇静时的心率变异性变化

Effects of Combination of Midazolam and Propofol Induced Sedation on Heart Rate Variability

目的 :观察心率变异性 (HRV)在咪唑安定、异丙酚及其复合镇静时的变化。方法 :选择ASAⅠ～Ⅱ级 ,在下胸腰段硬膜外阻滞下择期手术的成年病人 6 0例 ,随机分为四组 ,每组 15例 ,Ⅰ组为咪唑安定组 ,Ⅱ组为咪唑安定0 0 2 5mg/kg加异丙酚组 ,Ⅲ组为咪唑安定 0 0 5mg/kg加异丙酚组 ,Ⅳ组为异丙酚组。Ⅰ组、Ⅳ组每间隔 2～ 3分钟静注咪唑安定 1 5mg或异丙酚 2 0mg ;Ⅱ组、Ⅲ组先静注咪唑安定 0 0 2 5mg/kg或 0 0 5mg/kg ,4分钟后每间隔 2～ 3分钟给病人静注异丙酚 2 0mg ,直至警觉 /镇静评分值达到 1分。观察记录病人不同OAA/S评分值及评分值达到 1分后 5分钟时HRV、BP、HR和SpO2 的变化。结果 :各组病人HRV各成分均随镇静程度改变而变化。单纯咪唑安定、0 0 2 5mg/kg咪唑安定复合异丙酚、0 0 5mg/kg咪唑安定复合异丙酚组病人对LF、TP抑制较明显 ;单纯异丙酚组病人中HF抑制较为显著 ,复合用药组病人对HF抑制作用介于咪唑安定与异丙酚之间。结论 :对病人HRV功率谱分析可动态反映咪唑安定。

Objective: To investigate the effects of midazolam,propofol and both drugs co induction induced sedation on heart rate variability(HRV).Method:60 ASAⅠ～Ⅱ adult patients undergoing elective surgery under low thoracolumbar epidural anesthesia were randomly devided into four groups,i.e. group Ⅰ:midazolam only;group Ⅱ:0 025mg/kg midazolam combined with propofol;group Ⅲ:0 05mg/kg midazolam combined with propofol;group Ⅳ:propofol only.4 minute after 3ml of double blined introvenous bolus dose of 0 025mg/kg or 0 05mg/kg midazolam was administered.An introvenous bolus dose of propofol(20mg) in group Ⅱ、group Ⅲ、group Ⅳ or midazolam(1 5mg) in group Ⅰ was administered every 2～3 minutes until patients′ sedation level assessed by OAA/S scale reached to a score of 1.HRV、BP、HR and SpO 2 were studied at different OAA/S scores and at 5min after patients had OAA/S score of 1.Results:All frequency components of HRV were significantly reduced as patients′ OAA/S scores decreased in all groups.LF and TP were markedly inhibited in group Ⅰ、group Ⅱ and group Ⅲ;HF was increased in group Ⅰ,significantly reduced in group Ⅳ,but moderately decreased in group Ⅱ and group Ⅲ.Conclusion:Spectral analysis of HRV can indicate different effect of midazolam,propofol and both drugs co-induction on patients′ autonomic nervous activity quantitatively.