芬太尼对比咪达唑仑辅助硬膜外麻醉的临床观察

Clinical Observation of Therapeutic Efficacy of Assistant Epidural Anesthesia of Fentanyl versus Midazolam

目的：观察芬太尼对比咪达唑仑辅助硬膜外麻醉的疗效和安全性。方法：78例硬膜外麻醉患者按随机数字表法均分为观察组和对照组。所有患者于术前30 min给予苯巴比妥钠100 mg、阿托品0.5 mg,肌肉注射。监护仪监视心率（HR）、收缩压（SBP）、舒张压（DBP）、血氧饱和度（SPO2）。观察组患者术前10 min静脉注射芬太尼1μg/kg后,行硬膜外麻醉,选择手术位置的椎体间隙作为穿刺位点,硬膜外腔注入2%利多卡因3 ml,观察5 min,如无全脊麻醉征象后,分次追加2%利多卡因3 ml。对照组患者给予咪达唑仑0.04 mg/kg,静脉注射。两组患者均给予面罩吸氧4~6 L/min。观察两组患者的麻醉效果,麻醉前后静态疼痛视觉模拟（VAS）评分、Ramsay镇静评分、HR、SBP、DBP、SPO2及不良反应发生情况。结果：观察组患者总有效率显著高于对照组,两组比较差异有统计学意义（P〈0.05）。麻醉前两组患者HR、SBP、DBP、SPO2、VAS评分、Ramsay镇静评分比较,差异均无统计学意义（P〉0.05）;麻醉后两组患者HR、SBP、DBP、SPO2、Ramsay镇静评分均显著高于同组麻醉前,且对照组高于观察组,而VAS评分均显著低于同组麻醉前,且观察组低于对照组（P〈0.05）。两组患者麻醉期间均未见明显不良反应发生。结论：芬太尼辅助硬膜外麻醉较咪达唑仑效果更显著,且安全性较好。

OBJECTIVE：To observe therapeutic efficacy and safety of assistant epidural anesthesia of fentanyl and midazolam.METHODS：78 epidural anesthesia patients were randomly divided into observation group and control group. All patients were given phenobarbital sodium 100 mg and atropine 0.5 mg intramusculary 30 min before operation. HR,SBP,DBP and SPO2 were monitored by monitor. Observation group was given fentanyl 1 μg/kg intravenously 10 min before operation for epidural anesthesia,lumbar intervertebral space as puncture site,epidural injection of 2% lidocaine 3 ml,and then additional 2% lidocaine 3 ml if no spinal anesthesia sign after 5 min. Control group was given midazolam 0.04 mg/kg intravenously. Both groups inhaled oxygen4-6 L/min via face mask. Therapeutic efficacies of 2 groups were observed,and VAS,Ramsay,HR,SBP,DBP,SPO2 and ADR were observed before and after anesthesia. RESULTS：The total effective rate of observation group was higher than that of control group;there was statistical significance（P〈0.05）;HR,SBP,DBP,SPO2,VAS and Ramsay sedation score had no statistically significant difference between 2 groups before anesthesia（P〉0.05）;HR,SBP,DBP,SPO2 and Ramsay sedation score of 2groups after anesthesia were significantly higher than before anesthesia,and the control group was higher than the observation group;VAS of 2 groups was were significantly higher than before,and the observation group was lower than the control group（P〈0.05）. No significant ADR was found in 2 groups during anesthesia（P〈0.05）. CONCLUSIONS：The assistant epidural anesthesia of fentanyl is more effective and safer than midazolam.