咪达唑仑用于椎管内麻醉穿刺产生镇静与遗忘作用的合适剂量与给药时机  

Appropriate Dosage and Schedule of Midazolam Administration for Effects on Sedation,Amnesia by Intravertebral Puncture

作　　者：袁力勇[1] 戴体俊[2] 王霞民[1] 孙志强[1] 傅红[1] 

机构地区：[1]浙江省宁波市妇女儿童医院,315012 [2]徐州医学院江苏省麻醉学重点实验室,221002

出　　处：《医药导报》2008年第2期132-134,共3页Herald of Medicine

基　　金：国家自然科学基金资助项目(基金编号:39970715,30471657);江苏省自然科学基金资助项目(基金编号:BK2001143)

摘　　要：目的寻求咪达唑仑对椎管内麻醉穿刺时产生镇静、遗忘作用的合适给药时机和剂量。方法将240例ASAⅠ级患者分为椎管内麻醉穿刺操作前(A)组和操作后(B)组各120例;每大组又随机分为4小组,分别静脉给予0.01(M1组),0.03(M2组),0.1 mg.kg-1(M3组)咪达唑仑和0.9%氯化钠溶液(NS)组,每组30例。记录用药后警觉-镇静(OAA/S)评分和手术后1 h遗忘评分(AS)。结果OAA/S评分:A组和B组不同剂量M组与NS组比,OAA/S评分秩次差异有显著性;M2、M3组与M1组,M3组与M2组比较,镇静程度增加(P<0.05)。B组中M2、M3组分别与A组中M2、M3组比较,镇静程度增加(P<0.05);AS评分:A组不同剂量M组与NS组比较,各剂量M组遗忘程度大于NS组(P<0.05);M2、M3组与M1组比较,遗忘程度增加(P<0.05);M2和M3组遗忘程度相似(P>0.05);B组:M1、M2组与NS组遗忘程度相似(P>0.05);M1、M2和NS组分别与M3组比,M3组遗忘程度增加(P<0.05);B组中M3组遗忘程度不如A组中M3组(P<0.05)。结论椎管内麻醉穿刺操作前,0.03 mg.kg-1咪达唑仑静脉给药可以产生良好的镇静、遗忘作用,而对呼吸、循环影响较轻。Objective To seek the appropriate dosage and timing of midazolam administration for effects on sedation, amnesia by intravertebral puncture. Methods 240 grade ASA I patients undergoing total or sub-total hysterectomy were randomly allocated into 2 groups ： before puncture procedure of intravertebral anesthesia （groupA） and after puncture procedure （groupB）, 120 patients in each group,Each group was randomly divided into 4 sub-groups： midazolam 0.01 mg·kg^-1 （ M1 ）, midazolam 0.03 mg·kg^-1 （ M2 ）, midazolam 0.1 mg·kg^-1 （ M3 ） and normal saline （NS）. Drugs were administed by intravenous injection. Alertness and sedation （OAA/S） after midazolam administration and amnesia score （AS） 1 h after operation were recorded respectively. Results There was a significant difference between group A and group B, different dose groups of M compared to NS group for OAA/S evaluation; There was a increase trend of sedation in M2, M3 compared to M, , M3 compared to M2 （P 〈 0.05）, respectively. In group B, sedation effect increased in M2, M3 compared with M2, M3 in group A （P 〈 0.05） ; For AS evaluation, amnesia scores were significantly higher in sub-group M,, M2 and M3 compared to group NS of group A（ P 〈 0.05） ;amnesia scores in M2 and M3 were higher than those in M1 （P 〈 0.05 ） ;but was no significant difference between subgroup M2 and sub-group M3 （P 〉 0.05）. In group B：there was no significant difference in amnesia score between sub-group M1, M2 and NS group （P 〉 0.05 ） ; amnesia scores were higher in M3 compared with other sub-groups （P 〈 0.05 ） ; the sub-group M3 in group B showed lighter amnesia than that of sub-group M3 in group A （ P 〈 0.05 ）. Conclusion Intravenous injection of midazolam 0.03 mg ~ kg1 before intravertebral puncture could produces satisfactory effects of sedation, amnesia and produces light influences on respiration and circulation.

关 键 词：咪达唑仑 椎管内麻醉 穿刺 镇静 遗忘 剂量 时机 

分 类 号：R971.2[医药卫生—药品]