CT引导下放射性125Ⅰ粒子植入术中咪达唑仑镇静效果观察

An analysis of the effect of midazolam conscious sedation therapy in patients with 125I seed implantation

目的 探讨CT引导下放射性 125Ⅰ粒子植入术中应用咪达唑仑镇静治疗的临床效果。方法 选择2015年12月至2017年2月天津医科大学第二医院接受CT引导下放射性 125Ⅰ粒子植入术患者86例，按照动态随机化法分为咪达唑仑利多卡因组（观察组）和生理盐水利多卡因组（对照组），每组43例，观察组给予咪达唑仑清醒镇静联合利多卡因局部麻醉；对照组给予等量生理盐水静脉点滴联合利多卡因局部麻醉。观察并比较两组患者咪达唑仑给药前15 min（T0）、咪达唑仑/生理盐水给药后15 min（T1）、利多卡因局麻后15 min（T2）、穿刺病灶时（T3）、植入粒子时（T4）、手术结束后（T5）的心率、平均动脉压（MAP）、呼吸、氧饱和度（SpO2）变化，同时比较两组患者的体动反应、手术时间、利多卡因追加量、镇痛效果及不良反应情况。结果 观察组T1与T0相比心率、MAP、呼吸、SpO2均降低，差异有统计学意义（t=38.9、31.0、14.1、2.4，P〈0.05）；比较T1、T2、T3、T4、T5各时间点的心率、MAP、呼吸、SpO2的变化，差异均无统计学意义（P〉0.05）。对照组T3与T2相比，心率、MAP、呼吸均有所升高，差异有统计学意义（t=-23.6、-18.0、-9.5， P〈0.05），比较T1、T2、T3、T4、T5各时间点的心率、MAP、呼吸、SpO2的变化，差异均有统计学意义（F=997.3、833.7、120.1，77.5，P〈0.05）。观察组体动反应、手术时间、利多卡因追加量等指标及镇痛效果均优于对照组（t=-15.4、9.2、-56.3，P〈0.05）。结论 放射性 125Ⅰ粒子植入术中咪达唑仑用于清醒镇静可有效改善患者耐受性，更好的缩短手术时间，且安全性较高。

Objective To investigate the clinical effect of midazolam in CT-guided 125Ⅰ seed implantation. Methods Totally 86 patients who underwent CT-guided radioactive 125Ⅰ seed implantation were collected from December 2015 to February 2017 in the Second Hospital of Tianjin Medical University and randomly divided into two groups： the test group and the control group. The test group was given intravenous infusion of midazolam and local anesthesia of lidocaine while the control group were given the same amount of saline and lidocaine. The changes of heart rate （HR）, mean arterial pressure （MAP）, respiration （RR） and oxygen saturation （SpO2） were observed and compared between the two groups at 15 min before the midazolam（T0）, 15 min after the midazolam（T1）,15 min after lidocaine local anesthesia（T2）, the moments the lesion was punctured （T3）, and after implantation of the seeds （T4） and the end of the operation（T5）, respectively. In addition, the body reaction, operation time, the amount of lidocaine, the effect of analgesic and adverse reactions were also observed. Results The levels of HR, MAP,RR and SpO2 in test group were significantly lower than those in control group（t=38.9, 31.0, 14.1, 2.4, P〈0.05）, but there was no significant difference at T1, T2, T3, T4 and T5（P〉0.05）. In control group, HR, MAP and RR were significantly higher than those before operation （t=-23.6, -18.0, -9.5, P〈0.05）. The difference of HR, MAP,RR and SpO2 among T1, T2, T3, T4 and T5 was statistically significant （F=997.3, 833.7, 120.1, 77.5, P〈0.05）. In addition, the incidence of adverse reactions was both less in the two groups, and the incidence of response of patients, operation time, the amount of lidocaine and other indicators and analgesic effect in the test group were superior to the control group（-15.4,9.2,-56.3,P〈0.05）. Conclusions Midazolam in CT-guided 125Ⅰ particle implantation can improve the patient＇s tolerance and shorten the operation time, guarantec security.