麻醉苏醒期给予氟马西尼对右美托咪定或咪达唑仑麻醉诱导的全麻老年患者的影响

Effects of flumazenil on recovery from general anesthesia in elderly patients using midazolam or dexmedetomidine

目的 研究全麻老年患者麻醉苏醒期应用氟马西尼对围手术期右美托咪定或咪达唑仑镇静效果的影响。方法 拟在全麻下择期行胃肠肿瘤切除术老年患者48例,随机分为咪达唑仑组（M组）和右美托咪啶组（D组）,每组再分为两组,每组12例。M组和D组麻醉诱导时分别给予咪达唑仑0.06 mg·kg-1或右美托咪定1μg·kg-1,其余诱导药物及术中麻醉方法均相同,维持患者脑电双频指数（BIS）值40～60。术毕进入苏醒室即刻,M1组、D1组给予氯化钠注射液3 mL,M2组、D2组给予氟马西尼0.3 mg（用氯化钠注射液稀释至3 mL）。记录给药后每2 min的BIS值,连续16 min,并观察患者自主呼吸恢复时间、指令睁眼时间、拔管时间、指令握拳时间、回忆起出生日期时间。结果 M1组患者指令睁眼时间和指令握拳时间长于其他三组（P〈0.05）,其他三组组间均无显著差异（P〉0.05）。M1组拔管时间和回忆起出生日期时间长于M2组（P〈0.05）,与D1组、D2组间差异均无显著意义（P〉0.05）。M2组给药后4、6、8、10、12、14 min BIS值高于其他三组（P〈0.05）,其余三组间无显著差异（P〉0.05）。结论 氟马西尼可以改善接受咪达唑仑诱导的老年患者苏醒质量,对接受右美托咪定诱导的老年患者苏醒质量无明显影响。BIS监测可反映全麻老年患者苏醒期意识恢复状态。

AIM To study the effects of flumazenil on recovery from general anesthesia in elderly patients using midazolam or dexmedetomidine. METHODS A total of 48 elderly patients with ASA Ⅰ - Ⅱ underwent gastrointestinal surgery were randomized into four groups （n = 12）： midazola group （group MI）, midazola ＋ flumazenil group （group M2）, dexmedetomidine group （group D1）, dexmedetomidine ＋ flumazenil group （group D2）. The midazola （0.06 mg.kg-1） was used as sedative for induction in the group Mj and M2, while the dexmedetomidine （1μg.kg-1） was pumped more than 15 minutes in the group D1 and D2. The other anesthesia induction and maintenance were the same, and the bispectral index （BIS） was stabilized in 40 - 60. When the surgery was over, the patients were immediately transported to the recovery room and administrated with flumazenil 0.3 mg in the group M2 and D2, and sodium chloride injection 3 mL in the group M1 and D2. After termination of anesthesia, the time taken to spontaneous respiration as well as hand squeezing and eye opening on verbal command, extubation of endotracheal tube and recollection of their date of birth were measured. BIS values were also recorded in two-minute intervals in 16 minutes. RESULTS Mean time to hand squeezing, eye opening on verbal command were significantly longer in the group M1 （P 〈 0.05） compared with those in the other three groups, and no significant difference among them （P 〉 0.05）. The time to extubation and recollection of their date of birth in the group M~ were longer than those in the group M2 （P 〈 0.05） , but showed no significant difference with those in the group D1 and D2 （P 〉 0.05）. The BIS value at 4, 6, 8, 10, 12 and 14 min after administration in the group M2 were significantly higher than those in the other groups （P 〈 0.05） . There were no significant differences in BIS values among group M1, D2 and D2 （P 〉 0.05）. CONCLUSION Flumazenil can improve quality of recovery from general anesthesia in elderly patients using midazolam induction, but has no influence on those who using dexmedetomidine induction. BIS can be used for monitoring the elderly patients recovery state.