异丙酚联合咪唑安定在老年人单侧下肢手术中的镇静麻醉效果观察

The Effect of Propofol combined with Midazolam in the treatment of the Elderly Patients with Unilateral Lower Limb Surgery

目的:探究老年单侧下肢手术患者行异丙酚镇静麻醉、异丙酚联合咪唑安定麻醉的镇静麻醉效果差异。方法:选取2015年7月至2017年7月本院收治的老年单侧下肢手术患者86例为研究对象。根据简单随机分组方法将患者随机分两组,其中对照组(n=43)患者行异丙酚镇静麻醉,研究组(n=43)患者行异丙酚联合咪唑安定麻醉。观察两组麻醉前(T_0)、有效麻醉时间(T_1)、术中1.5h(T_2)、术毕(T_3)各时间的心率(HR)、平均动脉压(MAP)水平;采用镇静评分标准(Ramsay评分)评定患者镇静前、诱导期、术中、术毕的镇静程度;比较两组镇静起效时间、清醒时间、回答时间以及麻醉不良反应发生率。结果:两组的患者HR、MAP水平的组间差异性以及各时间点测量值的时间差异性显著(P<0.05)。研究组T1时HR、MAP水平明显低于T0时及对照组(P<0.05);T0、T2、T3时的HR、MAP水平比较差异无统计学意义(P>0.05)。镇静后(术中、术毕)研究组Ramsay镇静评分明显优于对照组,差异有统计学意义P<0.05)。研究组镇静起效时间、清醒时间、回答时间均明显短于对照组(P<0.05)。组间麻醉不良反应率比较无统计学差异(χ~2=1.400,P>0.05)。结论:两种方案应用于老年单侧下肢手术均具有较高安全性,但异丙酚联合咪唑安定麻醉镇静效果更理想,此方案镇静起效快,术中镇静程度深,术后患者清醒快,麻醉不良反应率低,因而颇具临床应用价值。

Objective:To explore the elderly patients with unilateral lower extremity surgery propofol anesthesia,propofol combined with midazolam anesthesia sedation anesthesia effect.Methods:From July 2015 to July 2017 in our hospital,86 cases of elderly patients with unilateral lower extremity surgery as the research object.Patients were randomly divided into two groups according to a simple randomized grouping method,the control group(n=43)treated with propofol anesthesia,study group(n=43)treated with propofol combined with midazolam anesthesia.Observe two groups before anesthesia(T 0)the effective time of anesthesia,intraoperative(T 1),1.5h(T 2),end of operation(T 3)each time the heart rate(HR),mean arterial pressure(MAP)level;the standard for evaluation of sedation(Ramsay score)were assessed before sedation,induction period,The degree of sedation during the operation and after operation was compared;the sedative onset time,awake time,response time and the rate of adverse reactions were compared between the two groups.Result:The patients of two groups with HR,MAP levels among different groups at different time points and measurements of time difference(P<0.05).The research group T 1 HR,T0 and MAP levels were significantly lower than the control group P<0.05);T 0,T 2,T 3 HR,no significant level of MAP the difference(P>0.05).After sedation(intraoperative,postoperative)study group Ramsay sedation score was significantly better than the control group,the difference was statistically significant(P<0.05).The study group sedation onset Time,waking time and response time were significantly shorter than those in the control group(P<0.05).There was no significant difference in the rate of adverse drug reactions between groups(χ2=1.400,P>0.05).Conclusion:Two schemes on elderly patients with unilateral lower extremity surgery has higher safety,but propofol combined with midazolam sedation effect is more ideal,the calm effect is fast,deep level of sedation,postoperative anesthesia in awake patients,low rate of adverse reactions,so it has the value of clinical application.