咪达唑仑与右美托咪定用于老年四肢手术中的镇静效果及患者不良反应分析

Sedation effect and adverse reaction analysis of midazolam and dexmedetomidine in limb surgery for the elderly patients

目的研究比较咪达唑仑与右美托咪定对老年四肢手术的镇静效果及患者的不良反应。方法取北京市红十字会急诊抢救中心2018年11月-2019年8月入院进行的四肢手术治疗的85例患者作为研究对象,把这85例研究对象用数学来分成分为三组,对照组(A组)35例、咪达唑仑组(B组)25例、右美托咪定组(C组)25例。所有患者先腰硬联合麻醉后,A组注射液10mL的0.6%氯化钠;B组予以咪达唑仑0.02mg/kg,稀释至10mL;C组予以右美托咪定0.65mg/kg,稀释至10mL;均使用注射泵将药品10min缓慢静脉内泵注。记录给药前(T0)、给药后10 min(T1)、切皮时(T2)、放置骨水泥(T3)、术毕(T4)时的平均动脉压(MVP)、血氧饱和度(SpO2)、心率、Ramsay镇静评分。结果 A组患者的SpO2、MVP、心率变化不大;在T1、T2、T3时B、C组的MVP均下降,但B组仍高于C组(P<0.05);在T2、T3时B组患者心率下降程度大于C组(P<0.05),但C组的血氧饱和度下降大于B组(P<0.05)。B、C组患者的Ramsay评分均> 3分。结论本研究通过本院的四肢手术患分成三组进行对比可以看出,对于患者来说,咪达唑仑镇静药物可能会造成患者呼吸不畅,不能保证患者的安全性,而注射右美托咪定的患者没有任何人发生恶心头晕、呕吐不止、抑制呼吸等不良反应,唯一的缺点就是有可能会造成患者心率减慢的趋势,综合对比应用右美托咪定的镇静效果最好,不良反应发生率低。

Objective To compare the sedative effects of midazolam and dexmedetomidine on elderly limb surgery and the adverse reactions of patients. Methods A total of 85 patients who were admitted to the Beijing Red Cross Emergency Rescue Center from November 2018 to August 2019 for limb surgery were selected as the research object. The 85 patients were divided into three groups by mathematics and the control group(Group A) 35 cases, midazolam group(Group B) 25 cases, dexmedetomidine group(Group C) 25 cases. After all patients underwent combined spinal-epidural anesthesia, group A was injected with 10 mL of 0.6% sodium chloride;group B was given midazolam 0.02 mg/kg and diluted to 10 mL;group C was given dexmedetomidine 0.65 mg/kg,Dilute to 10 mL;The medicine was pumped slowly intravenously for 10 minutes using a injection pump. Record the mean arterial pressure(MVP) and oxygen saturation(TVP), heart rate, Ramsay sedation score,before administration(T0), 10 min after administration(T1), skin incision(T2), bone cement placement(T3), and after surgery(T4) SpO2. Results The SpO2, MVP and heart rate of group A did not change much;the MVP of groups B and C decreased at T1, T2 and T3, but group B was still higher than group C(P < 0.05);at T2 and T3, The heart rate decreased more than group C(P < 0.05), but the blood oxygen saturation of group C decreased more than group B(P < 0.05). Ramsay scores of patients in groups B and C were all > 3 points. Conclusion In this study,though comparison we can see that midazolam sedative drugs may cause patients to have breathing difficulty, which cannot guarantee the safety of patients. None of the patients in the dexmedetomidine group experienced nausea, dizziness, vomiting, and respiratory depression. The only drawback is that they may cause the patient’s heart rate to slow down.The comprehensive comparison of the application of dexmedetomidine has the best sedative effect and the reaction rate is low.