咪达唑仑联合丙泊酚对全麻老龄患者苏醒期躁动及血流动力学影响

Effect of midazolam in combination with propofol on agitation and hemodynamic changes in elderly patients during general anesthesia

目的探讨咪达唑仑联合丙泊酚对全麻老龄患者苏醒期躁动及血流动力学影响。方法将从2014年1月至2015年2月收治的65岁以上、择期行腹部及骨科手术的全麻手术患者80例作为研究对象,按照入院先后顺序采用单双号数字表法分为观察组与对照组,每组各40例,对照组采用咪达唑仑联合芬太尼进行诱导及维持麻醉,观察组采用咪达唑仑联合丙泊酚诱导及维持麻醉,比较两组患者麻醉诱导前(T_0)、诱导1 min后(T_1)、气管插管前(T_2)、气管插管即刻(T_2)、气管插管第1 min(T_3)、气管插管第5 min(T_4)、气管插管第10 min(T_5)、气管插管第20 min(T_6)患者的MAP、HR变化情况血流动力学状况及全麻苏醒期躁动的发生率。结果观察组T_1、T_2、T_3、T_4、T_5、T_6的MAP及HR水平均较对照组低(所有P<0.05);观察组老年全麻患者苏醒期躁动分级Ⅰ级(5.0%vs 22.5%)及Ⅲ级(2.5%vs 17.5%)的比例均显著低于对照组,P<0.05。结论咪达唑仑联合丙泊酚更有利于维持全麻老龄患者的血流动力学稳定,降低全麻苏醒期躁动的发生率。

Objective To investigate the effect of midazolam combined with propofol on controlling emergence agitation and influencing hemodynamic changes in the awaking stage of general anesthesia. Methods From January 2014 to February 2015, 80 patients（more than 65 years old）undergoing abdominal and orthopaedic surgery were included in the study, and were assigned observation groups（n=40） and control group（n=40）. The patients of control group were treated midazolam combined fentanyl to induce and maintain general anesthesia, and those of observation group received midazolam in combination with propofol. The emergence agitation and hemodynamics in general anesthesia patients were observed and compared in two groups, including before anesthesia induction（T_0）, 1 min after induction（T_1）,（T_2） before the endotracheal intubation, endotracheal intubation（T_2） immediately 1min（T_3）, endotracheal intubation, endotracheal intubation, 5 min（T4）, endotracheal intubation, 10min（T_5）, endotracheal intubation, 20 min（T_6）. Results The levels of MAP and HR in T_1, T_2,T_3, T_4, T_5, T_6 in observation group were lower than that in control group（P〈 0.05）. Case number of stir class I and stir class Ⅲ during the awakening period in observation group was less than that in control group（5.0% vs 22.5%, 2.5% vs 17.5%, respectively, P〈 0.05）. Conclusion The present study showed that midazolam in combination with propofol was more advantageous to maintain hemodynamic stability of the aged patients with general anesthesia, reduce the incidence of general awakening period agitation.