咪唑安定配伍不同药物对辅助硬膜外麻醉的临床效果

Comparative study on midazolam with various combinations to supplement epidural anesthesia

目的 探讨咪唑安定与芬太尼、氟哌啶及氟哌合剂(氟哌啶与哌替啶 )配伍作为硬膜外辅助用药镇静、镇痛及预防术中不良反应的效果 .方法 ASA II～ III行择期腹部手术患者 80例 ,按辅助用药不同随机分为 4组 (n=2 0 ) :氟哌合剂组 (DP)、咪芬 (MF)、咪哌 (MP)合剂组及咪唑安定与氟哌合剂联合用药组 (MDP) .术前了解患者对镇静的要求 ,于硬膜外麻醉首剂量 5～ 10 m in后静脉给药 ,术中观察并记录给药后 10 m in内的 BP,HR和 Sp O2 变化 ,患者镇静程度 ,不良反应发生率 ,并于术后随访患者对术中情况有无遗忘及对麻醉效果的评价 .结果 6 9%患者对术中镇静有明确要求 ;4组辅助用药对循环呼吸的干扰无差异 .达到 Ramsay 4级镇静所需时间 MF:(1.5± 1.0 ) min,MP:(1.7± 1.1) min,MDP:(3.5± 2 .0 ) min、明显短于 DP组 :(5 .8± 2 .8) min(P<0 .0 5 ) ;而 MDP组维持 4级以上镇静的作用时间是 (115 .7± 16 .8) min显著长于其他 3组 [MP:(80 .0± 32 .1) min;DP:(6 8.0± 4 9.5 ) min;MF:(5 6 .4± 19.1) min](P<0 .0 5 ) ;伍用咪唑安定的 3组患者产生遗忘作用高于 DP组 ,且患者的满意度相对较高 (P<0 .0 5 ) ,但各组术中牵拉反应发生率无差异 ,MP与 MDP组舌后坠发生率较高 (P<0 .0 5 ) .

AIM To investigate the sedative, analgesic and preventive effects against side effects of intravenous administration of midazolam (M) with various combinations in patients undergoing abdominal surgery under epidural anesthesia. METHODS 80 ASA II^III patients, scheduled for elective abdominal surgery were randomized into four groups: Group DP, droperidol 5 mg + pethidine 100 mg as 1 U; Group MF, midazolam 4 mg + fantanyl 0.1 mg as 1 U; Group MP, midazolam 4 mg +pethidine 100 mg as 1 U and Group MDP, DP 1 U + midazolam 4 mg. All the drugs were intravenously injected 5~10 min after the first dose of epidural local anesthetic. The dose of various combinations was selected to reach sedation degree of Ramsay 4. The patients' requirement for sedation was asked preoperatively. The blood pressure, heart rate and SpO 2 were monitored, the degree of sedation and the side effects were recorded during the operation. The patients were visited to evaluate the effect of amnesia and satisfaction of anesthesia. RESULTS 68% patients had the clear requirement for sedation during the operation. There were no differences in the changes of blood pressure, heart rate, SpO 2 in all four groups. As for the time reaching Ramsay 4 of sedation degree, Group MF was (1.5± 1.0) min, MP (1.7±1.1) min and MDP (3.5±2.0) min was faster than that of group DP (5.8± 2.8 ) min ( P < 0.05 ). The sedative time above Ramsay 4 in Group MDP (115.7± 16.8 ) min was longer than those in the other three groups [MP: (80.0±32.1) min, DP: (68.0±49.5) min and MF: (56.4±19.1) min] ( P <0.05). The groups in which midazolam was used had better amnesia effect and higher patient satisfaction. However, no obvious difference was found in the incidence of responses to surgical exploration. There was a higher risk of falling tongue in groups MP and MDP than in other groups. CONCLUSION Midazolam combined with fentanyl is the most effective combination to supplement epidural anesthesia for 1~2 h operations. MF combination has the advantages of rapid onset time, remarkable amnesia, low interference in circulation and respiration and improved satisfaction of anesthesia. If the procedure lasts for more than 2 h and deeper sedation is required, the MDP combination is indicated.