不同诱导剂量的咪达唑仑麻醉对胸腔镜肺癌根治术后患者镇痛效果的影响

Radical cure effect of introducing different doses of midazolam anesthesia on postoperative analgesia in patients with thoracoscope lung carcinoma

目的探讨不同诱导剂量的咪达唑仑麻醉对胸腔镜肺癌根治术后患者镇痛效果的影响。方法选取2014年8月至2015年7月在本院进行胸腔镜肺癌根治术的82例患者,根据抽签法分为观察组(41例)和对照组(41例)。观察组使用0.1 mg/kg的咪达唑仑进行麻醉诱导,对照组使用剂量为0.05mg/kg的咪达唑仑予以麻醉诱导。比较两组患者术前术后48 h炎症因子水平、血氧饱和度、平均动脉压、心率变化情况,分析两组患者的手术情况。结果术后48 h,观察组的IL-6、IL-8、IL-1β、TNF-α炎症因子指标低于对照组[(58.43±3.21)μg/L、(2.03±0.25)μg/L、(2.97±0.43)μg/L、(5.32±0.76)μg/L比(96.43±4.53)μg/L、(3.22±0.32)μg/L、(3.76±0.43)μg/L、(7.63±0.98)μg/L](P<0.05)。术后48 h,观察组的血氧饱和度、平均动脉压、心率显著低于对照组[(93.78±1.07)%、(93.21±3.45)mm Hg、(87.54±2.34)次/min比(97.12±1.02)%、(96.43±4.02)mm Hg、(91.04±2.88)次/min](P<0.05)。两组患者的出血量、手术时间、麻醉时间比较无显著性差异(P>0.05),但观察组患者的睁眼时间、拔管时间显著短于对照组(P<0.05),术后疼痛评分、丙泊酚总用量、瑞芬太尼总量显著少于对照组(P<0.05)。结论在胸腔镜肺癌根治术患者中使用剂量为0.1 mg/kg的咪达唑仑进行麻醉诱导,相对于剂量为0.05 mg/kg的咪达唑仑,更能有效抑制患者的炎症反应,减少维持麻醉所需的麻醉药物使用量,确保患者围术期更加平稳,有效缓解患者术后疼痛感,属于较为理想的给药方案。

Objective To study radical cure effect of introducing different doses of midazolam anesthesia on postoperative analgesia in patients with thoraeoscope lung carcinoma. Methods Between August 2014 and July 2015, choosing 82 patients with thoracoscope lung cancer in our hospital, according to the draw method, they were divided into observation group （41 cases） and control group （41 patients）. Observation group were treated with 0.1 mg/kg of midazolam anesthesia induction, control group were given the dose of 0.05 mg/kg of midazolam for induction of anesthesia. Two groups of patients with preoperative and 48 h postoperative inflammatory factor levels, blood oxygen saturation, mean arterial pressure, heart rate changes were compared, the two groups of patients with surgery situation were analyzed. Results postoperative 48 h, observation group with IL - 6, IL -8, IL-1β, TNF alpha inflammation factor index were lower than the control group[ （58.43± 3.21）μg/L, （2.03±0.25）μg/L, （2.97±0.43）μg/L, （5.32±0.76）μg/L vs. （96.43±4.53）μg/L, （3.22± 0.32）μg/L, （3.76±0.43）μg/L, （7.63±0.98）μg/ L] （P〈0.05）. After 48 h surgery, observation group of blood oxygen saturation, mean arterial pressure, heart rate were significantly lower than the control group [（93.78±1.07） %, （ 93.21 ±3.45 ） mmHg, （87.54±2.34） time/min vs. （ 97.12±1.02） %, （96.43±4.02） mmHg, （91.04± 2.88） time/min] （P〈 0.05）. Two groups of patients with blood loss, operative time, anesthesia time had no significant difference （P〉0.05）, but the observation group of patients with open time, extubation time was significantly shorter than the control group （P〈0.05）, postoperative pain score, the total dosage of propofol, rui total fentanyl was significantly less than the control group （P〈0.05）. Conclusions In patients with thoracoscope lung cancer treated using dose of 0.1 mg/kg of midazolam anesthesia induction, relative to the dose of 0.05 mg/kg of midazolam, can effectively inhibit the inflammatory response, maintain anesthesia narcotic drug usage, to ensure more smoothly, the perioperative period in patients with effective alleviate postoperative pain patients, belongs to the ideal dosage regimen.