咪唑安定+芬太尼+阿曲库胺用于脊柱手术时氟马西尼唤醒试验的研究

A Clinical Investigate on Midazolam+Fentany +Atracurium Applied in Wake-up Test in Spinal Surgery

目的 探讨咪唑安定 +芬太尼 +阿曲库胺用于脊柱手术时氟马西尼唤醒试验。方法 6 0例ASAⅠ～Ⅱ级择期脊柱手术病人随机分为两组 ,(1)A组 :30例 ;(2 )B组 :30例。两组采用诱导麻醉后 ,A组采用微泵静脉持续输注咪唑安定 +芬太尼 +阿曲库胺 ,唤醒前 10min停用 ,等肌松恢复后给予氟马西尼拮抗 ,从而唤醒病人 ;B组采用持续吸入氨氟醚 +微泵静脉持续输注阿曲库胺 ,唤醒前 10min停用氨氟醚及肌松药 ,加大氧流量促使氨氟醚排出 ,直到病人清醒。分别监测诱导前、唤醒前 10min、唤醒前 5min、唤醒时、加深麻醉时及手术结束时 6个时段点的MAP、HR、SpO2 及R变化 ;并观察两组病人唤醒时间、术中知晓、唤醒期间术中躁动以及术后拔管时间。结果 A组唤醒时间低于B组 ,A组术中知晓明显低于B组 ,有显著性差异 (P <0 .0 5 ) ;唤醒期间术中躁动A组明显低于B组 ,有显著性差异 (P <0 .0 5 ) ;术后拔管时间A组明显低于B组 ,有显著性差异 (P <0 .0 5 ) ;两组病人唤醒前 5min及唤醒时两个时点HRB组明显快于A组 ,有显著性差异 (P <0 .0 5 ) ;唤醒时点MAP变化B组明显高于A组 ,有显著性差异 (P <0 .0 5 )。结论 咪唑安定 +芬太尼 +阿曲库胺用于脊柱手术时氟马西尼唤醒试验可控性强 ,重复性好 ,唤醒迅速 。

objective To explore the effects of midazolam+fentanyl+atracurium applied on waking up test in the patients undergoing spinal surgery.Methods Sixty ASAI～Iipatients,underwent elective spinal surgery,were randomly divided into two groups(Group A and B),thirty patinets each group.After anesthesia induction,in group A,continual infuse of midazolam+fentanyl+atracurium was performed with the infuse pump,until 10 min before wake up.After neuromuscular blockade fadeaway,the patients were waked up by giving flumazenil.In group B,continual inhalation enflurence,infuse atracurium until 10 min before wake up,increasing oxygen flow to speed enflurane being cleared away until the patients wake up.MAP、HR、SpO 2 and R were detected at following six periods:before induction、10 min before wake up、5 min before wake up、wake up、anethesia was deepened and at the end of operation.In addition,wake up time、awake during operation,annoy during wake up and tracheal outtubation time were observed.Results In group A wake up time,awake cases during operation,annoyed cases during wake up and tracheal out tubation were significantly lower than those in group B(P<0.05).Compared with group B,HR at 5 min before wake up and at wake up,MAP atwake up increased significantly in group A(P<0.05).Conclusion Midazolam+fentanyl+atracurium applied in wake up test in spinal surgery have such advantages as following:easy controllable and repeatable,wake-up rapidly and low rates of awake or annoyed during operation.