椎管内麻醉时咪达唑仑复合布托啡诺镇静对血糖和皮质醇及焦虑情绪的影响  

Effects of Intraoperative Sedation with Midazolam and Butorphanol during Intravertebral Anesthesia on Blood Glucose,Cortisol,and Anxiety of Patients

作　　者：李宏[1] 钟凤华[1] 梁慧明[1] 靳三庆[1] 蒋海[1] 

机构地区：[1]中山大学附属第六医院麻醉科,广东广州510655

出　　处：《中山大学学报（医学科学版）》2010年第6期847-851,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2010206)

摘　　要：【目的】观察椎管内麻醉时咪达唑仑复合布托啡诺镇静对患者血糖、皮质醇及焦虑情绪的影响,以探讨椎管内麻醉时复合静脉镇静的临床意义。【方法】40例在椎管内麻醉下手术的成年患者,随机分入镇静组(n=20)与对照组(n=20):镇静组按首量咪哒唑仑40μg/kg+布托啡诺15μg/kg及维持量每小时咪哒唑仑20μg/kg+布托啡诺7.5μg/kg给药;对照组为生理盐水按盲法要求给药。测定术前1d上午9时、入手术室后10min、手术开始后30min及手术结束时的血糖、血清皮质醇浓度;入手术室后15min、术后24h分别调查患者术前、术中的焦虑程度;记录麻醉前、给药后0、5、10、20、30、60min以及手术结束后0、10、20、30min患者的脑电双频谱指数(BIS)、镇静警觉评分(OAA/S)。【结果】麻醉前各项指标组间无统计学差异(P>0.05);镇静组患者术中OAA/S3～4分,BIS70～90,处于浅镇静状态;术中、术毕镇静组的血糖、皮质醇浓度明显低于对照组(P<0.05);镇静组术中的焦虑评分明显低于对照组(P<0.05)。【结论】椎管内麻醉期间咪达唑仑复合布托啡诺浅镇静能明显减轻患者的应激水平及焦虑程度。【Objective】 To investigate the effects of intraopetative sedation during intravertebral anesthesia with midazolam and butorphanol on blood glucose,serum cortisol and anxiety of patients. 【Methods】 Forty adult patients scheduled for operation under intravertebral anesthesia were randomly assigned to sedation group （n = 20） or control group （n = 20）. Patients in sedation group were sedated with midazolam 40 μg / kg and butorphanol 15 μg / kg intravenously as loading dose,midazolam 20 μg / kg / h and butorphanol 7.5 μg / kg / h intravenously as maintenance. Normal saline was infused in control group. Concentrations of blood glucose and serum cortisol were measured at 9 o＇clock in the morning of the day before surgery,10 min after entering operating room,30 min after beginning of surgery and immediately at the end of surgery. Pre-anesthesia anxiety scores were inquired and recorded at 15 min after entering operating room. Intraoperative anxiety scores were inquired and recorded at 24 h after surgery. Bispectral index （BIS） and the Observer＇s Assessment of Alertness / Sedation Scale （OAA / S） were recorded before sedation,at 0 min,5 min,10 min,20 min,30 min,60 min after beginning of sedation,and 0 min,10 min,20 min,30 min after surgery. 【Results】 There were no differences between groups in all indices before sedation （P 0.05）. Patients in sedation group were mildly or moderately sedated during operation,with BIS 70 -90 and OAA / S 3 -4. Concentrations of blood glucose and serum cortisol were significantly lower in sedation group than control group （P 0.05） at 30 min after beginning of surgery and at the end of surgery. The scores of intraoperative anxiety were significantly lower in sedation group than control group （P 0.05）. 【Conclusions】 Intraoperative sedation with midazolam and butorphanol during intravertebral anesthesia can reduce stress responsesand alleviate anxiety of patients.

关 键 词：椎管内麻醉 咪达唑仑 布托啡诺 术中镇静 血糖 血清皮质醇 焦虑情绪 

分 类 号：R614.4[医药卫生—麻醉学] R453.1[医药卫生—外科学]