咪哒唑仑用于颌面外科手术后留置气管导管患者的临床研究  

Clinical effects of midazolam on maxillofacial postoperative patients with nasotracheal intubation

作　　者：周丽华[1] 徐礼鲜[1] 安永谦[2] 张惠[1] 王瑞峰[1] 范莹盈[1] 

机构地区：[1]西安第四军医大学口腔医学院麻醉科,710032 [2]哈尔滨市211医院口腔科

出　　处：《实用口腔医学杂志》2007年第4期578-580,共3页Journal of Practical Stomatology

摘　　要：目的：观察咪哒唑仑对颌面外科手术后留置气管导管患者的镇静效果。方法：选择ASAI-Ⅱ级40例择期行颌面外科手术的患者，随机分为2组实施术后镇痛：舒芬太尼组（S组）和舒芬太尼-咪哒唑仑组（S-M组），每组20人。自患者清醒后开始镇痛泵持续静脉输注，背景剂量均为2ml／h。当术后患者感觉疼痛或呛咳、躁动时，由患者自控静脉镇痛（patient controlled intravenous analgesia，PCIA）。观察生命体征的变化、视觉模拟评分（VAS）和Ramsay评分、PCIA按压次数及术后24h的呛咳次数、患者耐受气管导管的满意程度和不良反应的发生率。结果：2组患者在镇痛开始后1、4、12、24和48h的VAS均较镇痛前显著下降（P〈0．01）；S—M组Ram—say评分在1、4、12h与镇痛前比较显著增高（P〈0．01），与同时间点s组比较亦显著增高（P〈0．05）；S-M组PCIA按压次数（5．4±2．4）显著低于S组（14．5±4．6）（P〈0．01）；S—M组术后24h的呛咳次数（3．2±1．1）亦显著低于S组（6．6±1．4）（P〈0．01）；S—M组患者对镇痛镇静的满意度（90％）显著高于S组（65％）（P〈0．05）。结论：舒芬太尼对于口腔颌面部术后患者能达到良好的镇痛效果，加用咪哒唑仑能达到更深的镇静程度。二者合用可以减少PCIA按压次数及术后24h的呛咳次数，使患者更好的耐受气管导管，同时无恶心呕吐等并发症发生，是一种更有效的镇痛镇静方法。Objective ：To observe the sedation effects of midazolam on maxillofacial postoperative patients with nasotracheal intubation. Methods ：40 cases were equally and randomly divided into two groups： sufentanil group （group S） and sufentanil-midazolam group（ group S-M ）. The continuous dose was 2 ml/h. If the patients feel uncomfortable, patient controlled intravenous analgesia （PCIA） was used. To observe the changes of circulation and respiration, the changes of visual analogue scale（VAS） and Ramsay score, the patients＇bucking times within 24 h and the PCIA times, patients＇total satisfactory degree and the complications during postoperative analgesia were recorded. Results：There were significant decreases in VAS of two groups after postoperative analgesia 1, 4, 12, 24, 48 hours（ P 〈 0.01 ）. Ramsay scores in group S-M were significant increased after postoperative 1,4, 12 h（P 〈0.01 ） , and were statistically higher when compared with the group S after postoperative 1,4 hours （P 〈 0.05 ）. In group S-M, PCIA times（ 5.4 ± 2.4 ） were significantly lower than group S （ 14.5 ± 4.6） （ P 〈 0.01 ） and the patients＇ bucking times within 24 h （3.2 ± 1.1 ） were also significantly lower than the group S（6.6 ± 1.4） （P 〈 0.01 ）. The patients＇total satisfactory degree in group S-M（90% ） were statistically higher when compared with group S（ 65% ） （P 〈 0.05 ）. Condution： Sufentanil is an effective method for maxillofacial postoperative analgesia. When combined with midazolam, they could get higher Ramsay score and decrease the PCIA times and the patients＇bucking times within 24 h, so the patients could have better tolerance for the nasotracheal intubation without the incidence of nausea or vomiting.

关 键 词：舒芬太尼 咪哒唑仑 颌面部手术 术后镇痛 

分 类 号：R782.054[医药卫生—口腔医学]