右美托咪定或咪达唑仑对依托咪酯镇静时肌阵挛的影响

EFFECT OF DEXMEDETOMIDINE OR MIDAZOLAM IN PREVENTION OF MYOCLONUS AFTER APPLICATION OF ETOMIDATE

目的观察右美托咪定、咪达唑仑对依托咪酯麻醉镇静时肌阵挛的影响。方法选择拟在椎管内麻醉下行择期下腹部或下肢手术患者90例,随机分为三组,依次为对照组、右美托咪定组、咪达唑仑组,分别预先静注等量(0.125ml/kg)生理盐水、右美托咪定0.5μg/kg、咪达唑仑0.03mg/kg,然后静注0.3mg/kg依托咪酯,观察并认真记录肌阵挛的发生情况和严重程度。结果右美托咪定组与咪达唑仑组的T0、T1及T2时间段的的BIS、MAP及HR值与对照组比较差异无统计学意义(P>0.05);右美托咪定组与咪达唑仑组比较,轻度以及总体肌阵挛的发生率均明显低于对照组,差异有统计学意义(P<0.05);右美托咪定组与咪达唑仑组间的轻度、中度以及总体肌阵挛的发生率无统计学意义(P>0.05)。结论右美托咪定或咪达唑仑可降低依托咪酯麻醉镇静时肌阵挛的发生率,减轻肌阵挛的程度,可以在临床上推广应用。

Objective To observe the clinical effects of pretreatment with dexmedetomidine or midazolam in prevention of myoclonus after in general anesthesia induction using etomidate.Methods Ninety ASA I-II patients 16-60 years old who underwent lower abdominal or lower limb surgery under CSEA were studied.They were randomly divided into three groups with30 cases each.Dexmedetomidine group received dexmedetomidine 0.5μg/kg,midazolam group received midazolam0.03mg/kg and control group received the same volume normal saline.All the patients were given etomidate（0.3mg/ kg）.Five minutes after pretreatment,the rate and severity of myoclonus were recorded.Results The value of BIS、MAP and HR of all patients had no statistically significant difference during T0,T1 and T2（P0.05）.Compared to the control group,the rate of medium myoclonus,severe myoclonus and total myoclonus in dexmedetomidine group and midazolam group were both lower（P〉0.05）.But the rate of medium myoclonus and total myoclonus between dexmedetomidine group and midazolam group had no statistically significant difference（P〉0.05）.Conclusion Pretreatment with dexmedetomidine or midazolam not only reduce the rate of myoclonus significantly,but also lower the degree of myoclonus.It should be popularized in clinical widely.