咪达唑仑对全凭静脉麻醉镇静程度的影响

Influence of Midazolam on depth of sedation in total intravenous anesthesia

目的观察咪达唑仑诱导对全凭静脉麻醉镇静程度的影响。方法选择60例择期行妇科腹腔镜手术患者，随机分为A、B两组（n=30），行丙泊酚全凭静脉麻醉。A组诱导时，静注丙泊酚2mg／kg；B组诱导时，静注咪达唑仑0．05mg／kg后静注丙泊酚2mg／kg。其余麻醉处理相同。记录整个麻醉过程中9个时点脑电双频指数（BIS）值及术中知晓情况。结果诱导前，两组患者均清醒（P〉0．05）；诱导后1min，两组BIS值均低于50（P〉0．05）；插管前、插管后、切皮时、诱导后30min、诱导后1h，A组BIS值均明显高于B组（P〈0．05）；诱导后2h，两组BIS值均处于60左右（P〉0．05）；苏醒时，两组BIS值处于80-90（P〉0．05）。组间苏醒时间比较无统计学差异（P〉0．05）。两组患者均对手术过程无显性记忆，可疑术中知晓率A组高于B组（P〈0．05）。结论诱导时使用咪达唑仑，可以增加全凭静脉麻醉的镇静深度，持续约2h，可减少术中知晓的风险。

Objective To investigate the influence of Midazolam on depth of sedation in total intravenous anesthesia. Methods Sixty patients undergoing elective gynecological laparoscopy were randomized into two groups （n = 30/group）. Group A was in- duced with Propofol （2 mg/kg）, while Group B was induced with Midazolam （0.05 mg/kg） before Propofol （2 mg/kg）. The other anesthesia treatment was the same. Bispectral index （BIS） at nine time points and intraoperative awareness were recorded in anesthesia. Results Before induction, patients in the two groups were awake （P 〉 0.05） ; 1 rain after induction, the BIS values of the two groups were below 50 （ P 〉 0.05） ; immediately before intubation, immediately after intubation, at the time of skin incision,30 min after induction and 1 hour after induction, the BIS values of Group A were significantly higher than that of Group B （ P 〈 0.05 ） ; 2 hours after induction, the BIS values of the two groups were about 60 （P 〉 0.05 ） ; the BIS values of the two groups were between 80 and 90 as soon as they recovered （P 〉 0.05 ）. There was no difference in recovery time between the two groups （ P 〉 0.05 ）. All the patients had no evident intraoperative awareness, but patients suspected of intraoperative awareness were more in Group A than in Group B （P 〈 0.05）. Conclusion Induction with Midazolam improves the depth of sedation in total intravenous anesthesia by about 2 hours so as to reduce the risk of intraoperative awareness.