咪达唑仑和右美托咪定用于椎管内麻醉辅助镇静时顺行性遗忘作用的比较研究

Comparative study of anterograde amnesia between midazolam and dexmedetomidine in spinal anesthesia assisted sedation

目的:比较咪达唑仑和右美托咪定用于椎管内麻醉辅助镇静时顺行性遗忘作用。方法:选取2020年2—8月在本院行椎管内麻醉的60例下肢或下腹部手术患者为研究对象,按照随机数字表法分为右美托咪定组和咪达唑仑组,麻醉成功后右美托咪定组给予右美托咪定0.5μg/kg,静脉滴注10 min,再持续泵注,速度维持在0.4μg/(kg·h);咪达唑仑组给予咪达唑仑0.05 mg/kg,静脉注射,达到负荷剂量后持续泵注,速度维持在0.04 mg/(kg·h)。比较两组患者镇静评分、遗忘测试以及不良反应。结果:麻醉后30 min,咪达唑仑组镇静评分明显高于右美托咪定组,差异显著(P<0.05);麻醉时、麻醉后60 min以及手术结束两组患者镇静评分差异无统计学意义(P>0.05);咪达唑仑组完全遗忘发生率明显高于右美托咪定组,差异显著(P<0.05);咪达唑仑组不良反应发生率为10.00%,右美托咪定组为6.67%,两组比较差异无统计学意义(P>0.05)。结论:相比于右美托咪定,椎管内麻醉中使用适量咪达唑仑,既能产生镇静作用,又能产生顺行性遗忘作用作用,利于手术开展,具有临床推广价值。

Objective:To compare the anterograde amnesia effects of midazolam and dexmedetomidine in spinal anesthesia-assisted sedation.Methods:According to the random number table method,60 patients with lower limb or lower abdominal surgery who underwent spinal anesthesia in our hospital from February 2020 to August 2020 were randomly divided into the dexmedetomidine group and the midazolam group.After successful anesthesia,the dexmedetomidine group was given dexmedetomidine 0.5μg/kg by intravenous drip for 10 min,and then the dexmedetomidine was given by continuous pump injection with the pump speed maintained at 0.4μg/(kg·h).The midazolam group was given midazolam 0.05 mg/kg intravenously.After reaching the loading dose,it was continuously pumped,and the speed was maintained at 0.04 mg/(kg·h).The sedation score,amnesia test,and adverse reactions were compared between the two groups.Results:30 minutes after anesthesia,the sedation score of the midazolam group was significantly higher than that of the dexmedetomidine group(P<0.05).There was no significant difference in sedation score between the two groups during anesthesia,60 minutes after anesthesia,and the end of operation(P>0.05).The incidence of complete amnesia in the midazolam group was significantly higher than that in the dexmedetomidine group(P<0.05).The incidence of adverse reactions was 10.00%in the midazolam group and 6.67%in the dexmedetomidine group,respectively.There was no significant difference between the two groups(P>0.05).Conclusion:Compared with dexmedetomidine,the use of midazolam in spinal anesthesia can not only produce sedative effect but also produce an anterograde amnesia effect,which is conducive to the operation and has clinical value.