咪达唑仑和芬太尼用于腰硬联合麻醉镇静的临床观察  

Effect of midazolam and fentanyl on combined spinal-epidural anesthesia and sedation

作　　者：李建[1] 林凤颜 毕超[1] 

机构地区：[1]海口市妇幼保健院麻醉科,海南海口570203

出　　处：《海南医学院学报》2009年第8期950-951,954,共3页Journal of Hainan Medical University

基　　金：海南医学院科研基金资助学报项目(0020090112)~~

摘　　要：目的:观察不同剂量咪达唑仑加芬太尼用于腰硬联合麻醉镇静的临床效果。方法:80例ASAⅠ～Ⅱ级下腹部手术患者随机分为I、II、III、IV4组,分别采用0.02、0.04、0.06和0.08mg/kg咪达唑仑辅助芬太尼0.001mg/kg进行腰硬联合麻醉镇静,以改良警觉/镇静评分法(OAA/S)记录给药不同时间患者的镇静程度、遗忘程度,观察术中患者生命体征的变化。结果:给药后5minⅠ组、Ⅱ组OAA/S评分明显高于Ⅲ组、Ⅳ组(P<0.05),给药后10、30、60minⅠ组OAA/S评分明显高于Ⅱ、Ⅲ、Ⅳ组(P<0.05～0.01)。给药后30minⅡ、Ⅲ、Ⅳ组遗忘作用均优于Ⅰ组,Ⅲ、Ⅳ组优于Ⅱ组(P<0.05),给药后120minⅢ、Ⅳ组遗忘作用优于Ⅰ、Ⅱ组(P<0.05)。镇静、遗忘程度依次为Ⅳ组>Ⅲ组>Ⅱ组>Ⅰ组。4组各生命体征指标差异无统计学意义(P>0.05),均未发生严重的血压下降,Ⅳ组呼吸抑制发生率最高。结论:0.04～0.06mg/kg咪达唑仑辅助0.001mg/kg芬太尼较适用于腰硬联合麻醉的镇静、遗忘剂量。Objective ： To determine the effects of different doses of midazolam and fentanyl on combined spinal-epidural anesthesia and sedation. Methods： Eighty patients undergoing grade ASA Ⅰ - Ⅱlower abdominal surgery were divided randomly into 4 groups ： group Ⅰ, Ⅱ, Ⅲ and Ⅳ ; 0.02,0.04,0.06 and 0.08 mg / kg midazolam and 0.001 mg / kg fentanyl were used respectively for combined spinal-epidural anesthesia and sedation, and degrees of sedation, oblivion were recorded at different time of drug administration according to modified Observer＇s Assessment of Alertness/Sedation Scale （OAA/S） , with observation of changes of vital signs. Results： OAA / S scores in group Ⅰ and Ⅱ5 min after administration were significantly higher than that in group m and Ⅳ （ P 〈 0. 05 ）, OAA / S score in group Ⅰ 10,30,60 rain after administration was significantly higher than that in group Ⅱ, Ⅲ, Ⅳ（P 〈0.05 - 0. 01）. 30 min after administration, the forgeting degrees in group Ⅱ , Ⅲ, Ⅳ were all better than that in groupⅠ , andⅢ, Ⅳgroup were better than that in group Ⅱ（P 〈0.05） ; 120 min after administration, the forgeting degrees in group Ⅲ, Ⅳ were better than that in group Ⅰ, Ⅱ （ P 〈 0.05 ）. The order of degrees of sedation and oblivion was group Ⅳ 〉 group m 〉 group Ⅱ〉 group Ⅰ. Indicators of the vital signs between the 4 groups were no significant differences （P 〉 0. 05） , no serious low blood pressure occurred, respiratory depression occurred more in group Ⅳ. Conclusion ： 0. 04 - 0. 06 mg/ kg midazolam combined with 0. 001 mg / kg fentanyl is the appropriate dosage for sedation and oblivion of combined spinal-epidural anesthesia.

关 键 词：咪达唑仑 芬太尼 镇静 遗忘 

分 类 号：R73[医药卫生—肿瘤] R5[医药卫生—临床医学]