肺叶切除患者应用咪达唑仑联合地佐辛麻醉的临床观察

Clinical observation of anesthesia effects of midazolam combined with dezocine in patients undergoing pulmonary lobectomy

目的探讨对肺叶切除患者予以咪达唑仑(MID)联合地佐辛(DEZ)麻醉的临床有效性。方法选择120例择期行肺叶切除手术且采用胸椎旁阻滞麻醉方式的患者,按随机数字表法分为生理盐水组(N组)、咪达唑仑组(M组)、地佐辛组(D组)和咪达唑仑+地佐辛组(M+D组),每组30例。患者在T0(给药前)、T1(给药后5 min)、T2(椎旁阻滞时)、T3(椎旁阻滞后10 min)4个时间点分别采取常规方法对有创平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)、血氧饱和度(SpO_2)进行测定,并对本次镇静效果进行评价。结果与N组相比较,T1~T3时(M+D)组患者MAP明显下降(P<0.05),且显著低于M组和D组(P<0.05);T1~T3时,(M+D)组患者HR下降明显(P<0.05);与N组相比较,M组、D组和(M+D)组患者的BIS均有下降(P<0.05),且与T0相比较,T1~T3时(M+D)组患者的BIS下降明显(P<0.05),且显著低于M组和D组(P<0.05);T1~T3时,4组患者SpO_2差异无统计学意义(P>0.05);与N组相比较,其他3组患者OAA/S评分均显著上升(P<0.05),且(M+D)组明显高于M组和D组(P<0.05),T1~T3时,4组患者VAS评分进行比较,(M+D)组患者VAS下降最明显(P<0.05)。结论在肺叶切除手术中予以患者咪达唑仑联合地佐辛麻醉,患者术中镇静及镇痛效果良好。

Objective To explore the clinical efficacy of anaesthesia of midazolam combined with dezocine in patients undergoing pulmonary lobectomy. Methods A total of 120 patients who underwent pulmonary lobectomy with thoracic vertebra paravertebral block anesthesia in our hospital from June 2015 to June 2016 were enrolled in the atusy. According to random number table method,these patients were divided into normal saline group（ group N）,midazolam group（ group M）,dezocine group（ group D） and midazolam ＋ dezocine group（ M ＋ D group）,with 30 cases in each group. The mean arterial pressure（ MAP）,heart rate（ HR）,bispectral index（ BIS） and oxygen saturation（ SpO2） were measured by conventional method at 4 time points,respectively including T0（ before dosing）,T1（ 5 min after dosing）,T2（ paravertebral anesthesia）and T3（ 10 min after paravertebral block）. Moreover the sedative effects were evaluated. Results As compared with that in control grouo,the MAP at T1 T3 in M ＋ D group was significantly decreased（ P 〈 0. 05）,moreover,which was significantly lower than that in group M and group D（ P 〈 0. 05）,and the HR at T1 T3 in M ＋ D group was significantly decreased（ P 〈0. 05）. As compared with that in group N,the BIS in group M,group D and M ＋ D group was significantly decreased（ P 〈0. 05）. Moreover the BIS at T1 T3 in M ＋ D group was significantly decreased,as compared with that at T0（ P 〈 0. 05）,which was significantly lower than that in group M and group D（ P 〈 0. 05）. There was no significant difference in SpO2 at T1 T3 among the four groups（ P 〉 0. 05）. As compared with those in group N The OAA/S scores in group M,group D and（ M＋ D group were significantly increased（ P 〈 0. 05）,moreover,the OAA/S scores in M ＋ D group were significantly higher than those in group M and group D（ P 〈 0. 05）. In addition the decrease degree of VAS scores at T1 T3 in M ＋ D group was the most obvious among the four groups（ P 〈 0. 05）. Conclusion The midazolam combined with dezocine has favorable anesthesia and sedation in patients undergoing pulmonary lobectomy.