不同镇静药物用于术中镇静效果的比较

Comparison of the perioperative sedative effect of different sedative drugs in patient controlled sedation technology

目的 比较咪达唑仑、右美托咪定、丙泊酚和依托咪酯在术中患者自控镇静的效果。方法 择期行腰硬联合麻醉（CSEA）患者120例,ASAⅠ~Ⅱ级,年龄30~60岁。随机分成右美托咪定组（D组）、丙泊酚组（P组）、依托咪酯组（E组）和咪达唑仑组（M组）。记录入室时（T0）、给药后5 min（T1）、15 min（T2）、30 min（T3）、60 min（T4）和术毕（T5）患者的心率（HR）、平均动脉压（MAP）、脉氧饱和度（Sp O2）、脑电双频指数BIS、Ramsay镇静评分以及不良反应,观察4组患者术中镇静的效果。结果 14组患者年龄、身高、体重、手术时间、基础MAP和HR等基本资料上差异无统计学意义（P〉0.05）。2与T0时比较,T1~T4时4组患者HR、MAP、BIS均明显降低,Ramsay镇静评分明显升高（P〈0.05）;T2~T4时D组患者HR、MAP波动较M组、P组和E组平稳（P〈0.05）。3术中D组发生心动过缓6例,与其它3组比较差异存在统计学意义（P〈0.05）;E组发生注射痛7例,与其它3组比较差异存在统计学意义（P〈0.05）;呼吸抑制及低血压等其它不良反应发生率差异无统计学意义（P〉0.05）。结论 患者术中自控镇静时使用右美托咪定、依托咪酯和咪达唑仑是安全可行的,其中右美托咪定的镇静效果优于依托咪酯、丙泊酚和咪达唑仑。

Objective To compare the sedative effect of etomidate, propofol, midazolam and dexmedetomidine in patient controlled sedation technology. Methods 120 patients,ASA Ⅰ-Ⅱ, aged 30 to 60 years, scheduled for CSEA, were e- qually randomized into four groups ： dexmedetomidine （ group D）, propofol （ group P）, etomidate （ group E ） and midazolam （ group M）. HR（ heart rate）, MAP（ mean arterial pressure）, SpO2, BIS（ bispectral index values）, ramsay sedation score and adverse reactions were recorded at the time point of inter-room（T0） ,5 min after administration（ T1 ）, 15 min after ad- ministration （T2 ） ,30 rain after administration （ T3 ）, 60 rain after administration （ T4 ） and at the end of operation （ T5 ）, then the sedative effect during the surgery was observed. Results There were no significant difference in age, height, weight,operative time,basic MAP and HR and other general information among the four groups （ P 〉 0.05 ）. Compared with To, the MAP, HR and BIS decreased significantly, and Rasmay scores were significantly increased from the time point T1 to T4 in the four groups（P 〈0.05）. At the time point T2 to T4 ,the HR and MAP in group D were better than those in group E, group P and group M （P 〈 0.05 ）. During the operation among the four groups, six cases of intraoperative brady- cardia occurred in group D（P 〈 0.05） and seven cases of injection pain occurred in E group（P 〈 0.05 ）, and the inci- dence of other adverse events such as respiratory depression and hypotension was no significant difference （ P 〉 0.05 ）. Conclusion During CSEA, using dexmedetomidine, propofol, etomidate and midazolam in patient controlled sedation are safe and feasible, and the sedative effect of dexmedetomidine is better than etomidate,propofol and midazolam.