咪达唑仑持续泵入用于蛛网膜下腔出血患者术前镇静观察

Observations of midazolam continuing microdosis pump at the treatment of subarachnoid hemorrhage before operation

目的:探讨咪达唑仑持续泵入用于蛛网膜下腔出血患者围手术期镇静疗效。方法:回顾性分析2010-08-2012-08我院神经外科收治的128例蛛网膜下腔出血患者术前应用镇静期药物的临床资料,根据患者术前用药将128例患者分为苯巴比妥组(65例)、咪达唑仑组(63例)。结果:咪达唑仑组镇静深度优于苯巴比妥组[(0.80±1.29)分vs(2.47±0.48)分,t=1.98,P=0.047],生命体征更为平稳,手术麻醉诱引时间更短[(3.40±2.10)min vs(6.60±2.50)min,t=2.04,P=0.032],且管道非正常脱离发生事件更少[3例vs 13例,χ2=4.3,P=0.023],但低血压和呼吸抑制事件并未明显增多,也并未出现苏醒延迟时间延迟情况;虽然手术时间和造影剂用量组间差异不具有统计学意义,但咪达唑仑组仍低于苯巴比妥组。结论:研究观察认咪达唑仑可通过持续微量泵入的方式,获得并且维持较好的镇静、镇痛效果,并没增加低血压及抑制呼吸的发生风险,安全性较好。

Objective：To evaluate observations for midazolam continuing microdosis pump at the treatment of subarachnoid hemorrhage before the operation.Method：Retrospective analyze clinical data of 128 patients with subarachnoid hemorrhage admitted by neurosurgery department of the People＇s Hospital of Baoan Shenzhen.The 128 patients were divided into phenobarbital group（n=65）and midazolam group（n=63）.Result：The difference of vital signs and the Ramsay sedation score between the two groups indicated the better performance of midazolam continuing microdosis pump,（2.47±0.48）scores vs（0.80±1.29）scores（F=1.98,P=0.047）,which follows with the less time for inducing anesthetization（6.60±2.50）min vs（3.40±2.10）min（F=2.04,P=0.032）and less rates of unnormal pipe riding,13 vs 3（χ2=4.3,P=0.023）.Then the side effect such as the occurrence of hypotension and resparatory depression was not increased,including the delay of revive.Although no statistical difference between the two groups on the operational time and receiving the dose of radiocontrast agent,the midazolam group gains less records.Conclusion：Research suggests the better sedation effect could be received by the application of midazolam,followed by the reliable safety with the decreasing risk of hypotension and reparatory depression.