同等剂量咪达唑仑对不同年龄腰硬联合麻醉患者镇静遗忘的研究

Study on sedation and amnesia of patients with different ages of lumbar epidural anesthesia in equal doses of midazolam

目的研究同等剂量咪达唑仑对不同年龄腰硬联合麻醉患者镇静遗忘情况的影响。方法选取2015年1月~7月于西安交通大学附属第一医院就诊,拟择期在腰硬联合麻醉下施行下腹部手术,美国麻醉医师学会(ASA)分级Ⅰ~Ⅱ级的患者235例,按患者年龄分为3组:年轻组(YG,n=70);中年组(MG,n=82);老年组(OG,n=83)。术中持续监测各项呼吸、循环功能指标,记录注射咪达唑仑前及注射后5、15、30 min的MAP、HR、Sp O2情况,并进行镇静评分和遗忘测试,术后24 h随访患者遗忘情况,进行遗忘程度评级,同时观察3组患者术后不良反应情况。结果使用咪达唑仑前后MAP、HR、Sp O23组间同一时间点比较,各指标间差异无统计学意义。同一组不同时间点比较,MAP(FYG=9.2547,FMG=12.8181,FOG=17.77)和Sp O2(FYG=190.3835,FMG=196.2393,FOG=270.5609)有显著性差异,HR各组间及同组不同时间点比较,差异均无统计学意义;遗忘程度、镇静评分在YG和MG组间比较差异无统计学意义,但与OG组比较差异明显(P<0.05)。术后YG组和MG组患者不良反应总例数少于OG组(X2=11.2516,X2=10.4491,P<0.05)。结论同等剂量咪达唑仑对不同年龄腰硬联合麻醉患者的镇静遗忘效果不同,老年患者顺行性遗忘程度更强,会产生较多不良反应。因此在腰硬联合麻醉中,要慎重考虑患者的个体性差异,合理使用镇静麻醉药物。

Objective To study the sedation and amnesia of midazolam in patients with different ages of lumbar epidural anesthesia.Methods From January to July 2015,235 patients in the first affiliated of xian jiaotong unniversity,who were implemented abdominal surgery under combined spinal epidural anesthesia and American Society of anesthesiologists( ASA) grade was I-II,were divided into three groups: young group( n =70); middle-aged group( n = 82); elderly group( n = 83). Intraoperative continuous monitoring of respiratory and circulatory function index,and recorded MAP,Sp O2,HR before and 5,15,30 min after injection. Results MAP,HR and Sp O2 of three groups were compared with the same time points pre- and post used of midazolam,there was no significant difference among indicators.; Compared with the same group at different time points,MAP( FYG= 9. 2547,FMG= 12. 8181,FOG= 17. 77) 和 Sp O2( FYG= 190. 3835,FMG= 196. 2393,FOG= 270. 5609),there were significant difference. The difference was not statistically significant between HR group and the same group at different time points and forgetting degree and sedation score,but compared with OG,there were significant difference( P < 0. 05). The total number of adverse reactions in YG group and MG group was less than that of OG group( X2= 11. 2516,X2= 10. 4491,P < 0. 05). Conclusion The effect of the same dose of midazolam on sedation and amnesia in patients with different ages of lumbar epidural anesthesia is different,and the degree of the effect of the elderly patients is significant,but will produce more adverse reactions. Therefore,in the combined spinal epidural anesthesia,it is necessary to consider the patient's individual differences,rational use of sedative and narcotic drugs.