硬膜外麻醉手术患者术中清醒镇静中咪达唑仑靶控输注的应用效果

Application Effect of Midazolam Target Controlled Infusion during Intraoperative Awake Sedation in Patients Undergoing Epidural Anesthesia

目的:研究硬膜外麻醉手术患者采用靶控输注咪达唑仑的方式实施术中清醒镇静的临床效果。方法:选择2018年12月-2019年12月在笔者所在医院接受硬膜外麻醉手术的患者60例,通过随机分组方式分成对照组和研究组,每组30例。对照组采用利多卡因实施清醒镇静,研究组采用靶控输注咪达唑仑的方式实施术中清醒镇静。对比两组术后不同时间点疼痛程度和心理状态评分、麻醉前后生命体征指标水平、对麻醉方案满意度、麻醉不良反应情况、术后麻醉效果完全消失时间和住院总时间。结果:术后3 d两组VAS评分及HAMA、HAMD量表评分均低于术后当天,且研究组评分均低于对照组,差异均有统计学意义(P<0.05);麻醉后两组平均动脉压、心率均低于麻醉前,但研究组均高于对照组,差异均有统计学意义(P<0.05);研究组麻醉总满意度为93.3%,高于对照组的70.0%,研究组麻醉不良反应发生率为3.3%,低于对照组的20.0%,研究组麻醉效果消失时间和住院总时间均短于对照组,差异均有统计学意义(P<0.05)。结论:硬膜外麻醉手术患者采用靶控输注咪达唑仑的方式实施术中清醒镇静,可以使生命体征指标保持稳定,大幅度减轻疼痛,减少相关不良反应的出现,缩短住院治疗时间,提高患者满意度。

Objective:To study the clinical effect of target controlled infusion of Midazolam during intraoperative awake sedation in patients undergoing epidural anesthesia.Method:A total of 60 patients undergoing epidural anesthesia in our hospital from December 2018 to December 2019 were selected,and were randomly divided into the control group and the study group,with 30 patients in each group.The control group was sedated by Lidocaine,and the study group was sedated by target controlled infusion of Midazolam.The pain degree and mental state score at different time points after operation,the level of vital signs before and after anesthesia,the satisfaction of anesthesia program,the adverse reactions of anesthesia,the time of complete disappearance of anesthesia effect and the total time of hospitalization were compared between the two groups.Result:The VAS scores,HAMA and HAMD scales in both groups were lower than those in the control group 3 days after surgery,and scores in the study group were lower than those in the control group,the differences were statistically significant (P<0.05).After anesthesia,the average arterial pressure and heart rate in the two groups were lower than those before anesthesia,however,the study group was higher than the control group,the differences were statistically significant (P<0.05).The total satisfaction with anesthesia in the study group was 93.3%,higher than 70.0% in the control group,the incidence of adverse reactions in the study group was 3.3%,lower than 20.0% in the control group,the disappearance time of anesthetic effect and total length of hospital stay in the study group were shorter than those in the control group,the differences were statistically significant (P<0.05).Conclusion:Target controlled infusion of Midazolam can keep the vital signs stable,reduce the pain,reduce the occurrence of related adverse reactions,shorten the time of hospitalization and improve the satisfaction level of patients.