咪达唑仑复合地佐辛与芬太尼对硬膜外麻醉下阑尾牵拉反射作用的观察

Effect of midazolam combining dezocine or fentanyl on visceral traction reaction during appendec- tomy under epidural anesthesia

目的探讨咪达唑仑分别复合地佐辛与芬太尼对抑制硬膜外麻醉下阑尾牵拉反射的作用。方法选择阑尾切除术患者120例，ASAI～Ⅱ级，将患者随机分为A、B、C3组（每组40例），行硬膜外麻醉。术前5min，A组静注咪达唑仑0．04mg／kg；B组静注咪达唑仑0．04mg／kg和芬太尼2／zg／kg；C组静注咪达唑仑0．04mg／kg和地佐辛0．15mg／kg。记录3组患者切皮前5min、切皮时、打开腹膜时、牵拉阑尾时的平均动脉压、心率、氧饱和度值，评估牵拉阑尾时患者的临床反应和术中呼吸抑制情况。结果与A组比较，B、C组血流动力学更稳定（P〈0．05），临床反应优良率高（P〈0．05），B组呼吸抑制更多（P〈0．05）。结论咪达唑仑分别复合地佐辛与芬太尼均能较好抑制阑尾牵拉反射，但地佐辛呼吸抑制更少，更安全。

Objective To observe the effect of midazolam combining dezocine or fentanyl on in- hibiting visceral traction reaction during appendectomy under epidural anesthesia. Methods A total of 120 ASA I - ]I patients undergoing appendectomy under epidural anesthesia（ age 18 -56 years, weight 45 - 85 kg）were randomly divided into group A, B and C （n = 40）. At 5 min before operation, group A were given midazolam （ 0.04 mg/kg） by intravenous injection, group B were given midazolam （ 0.04 mg/ kg） and fentanyl（2 i.Lg/kg）by intravenous injection and group C were given midazolam（0.04 mg/kg）and dezocine （0.15 mg/kg）by intravenous injection. The vital signs including MAP,HR and SpO2 were recor- ded at the time points of 5 min before operation, cutting the skin, opening the peritoneum and pulling the appendix. The visceral traction reaction and respiratory inhibition were evaluated during operation. Results Hemodynamics of group B and C were more stable than group A （ P 〈 0.05 ）. Excellent rates of group B and C were higher than group A（ P 〈 0.05 ）. Respiratory inhibition of group B was more than group A and C （P 〈 0. 05）. Conclusion Midazolam combining dezocine or fentanyl are significantly effective on inhibiting visceral traction reaction during appendectomy under epidural anesthesia, but midazolam combining dezocine are safer because of the relatively weak inhibition of respire.