小剂量咪达唑仑注入蛛网膜下腔镇静效应的临床研究  

Sedation of small dose midazolam injected into subarachnoid cavity:a clinical study

作　　者：王钊[1] 朱昭琼[1] 喻田[1] 谢冕[1] 余志豪[1] 

机构地区：[1]遵义医学院附属医院麻醉科,贵州遵义563003

出　　处：《第三军医大学学报》2011年第18期1983-1985,共3页Journal of Third Military Medical University

摘　　要：目的观察咪达唑仑(midazolam,MIZ)注入蛛网膜下腔用于腰麻时的镇静作用、效能与剂量的关系,并与肌注、静脉注射的效果进行比较。方法筛选我院2008年12月至2009年6月收治拟于腰麻下行下腹部和下肢的择期手术患者共200例,男性82例,女性118例,年龄16～50(34.5±16.3)岁。分为4组(n=50)。腰麻药A、B组为0.75%布比卡因1.6 ml+50%葡萄糖0.4 ml配制:A组,患者腰穿注药后平卧,立即静脉注射MIZ 2 mg;B组,患者腰穿注药后平卧,立即肌肉注射MIZ 2 mg。C组:腰麻药为0.75%布比卡因1.6 ml+50%葡萄糖0.4 ml+5 mg/ml MIZ 0.2 ml。D组:腰麻药为0.75%布比卡因1.6 ml+50%葡萄糖0.4 ml+5 mg/ml MIZ 0.4 ml。比较患者在不同途径注射MIZ 5～60 min内不同时刻的镇静程度的变化和血压、心率、脉搏氧饱和度以及舌后坠的发生情况。结果 B组镇静评分小于A组(P<0.01),D组评分高于A组(P<0.01),C组评分高于A组(P<0.05);4组中仅D组有舌后坠的发生,与A、B、C组差异有统计学意义(P<0.05)。结论腰麻药内加入小剂量MIZ可产生良好的镇静效果,其作用与剂量相关且较同等剂量药物肌注或静脉内注射明显,可能和与其相应受体结合而产生中枢神经系统的抑制有关。Objective To observe the sedation of midazolam（MIZ）injected into subarachnoid cavity for lumbar anesthesia and its dose-response relationship,and compare with that of MIZ injected via muscles and veins.Methods Two hundred patients（82 males and 118 females） at the age of 16-50（mean 34.5±16.3） admitted to our hospital for lower abdominal and extremity operation under lumbar anesthesia from December 2008 to June 2009 were enrolled in this study.The patients were randomly divided groups A to D（50 in each group）.Patients in group A received lumber anesthesia with 2 mg MIZ through the vein and those in group B received lumber anesthesia with 2 mg MIZ through muscles,while patients in group C received lumber anesthesia with 1.6 ml 0.75% bupivacaine ＋0.4 ml 50% glucose solution ＋0.2 ml 5 mg/ml MIZ through muscles and those in group D received lumber anesthesia with 1.6 ml 0.75% bupivacaine ＋0.4 ml 50% glucose solution ＋0.4 ml 5 mg/mL MIZ through vein.From 5 to 60 min after MIZ injection,sedation,blood pressure,heart rate,pulse oxygen saturation,and glossoptosis in 4 groups were compared.Results The sedation score was lower in group B than in group A and higher in groups D and C than in group A（P0.01 or P0.05）.No glossocoma occurred in groups A to C except in group D（P0.05）.Conclusion Lumber anesthetics plus a small dose of MIZ can produce a rather good sedation.The sedation of MIZ is more significant than that of other anesthetics injected through muscles or veins,which may be related with the inhibition of central nervous system due to the binding of MIZ to its corresponding receptors in subarachnoid cavity.

关 键 词：咪达唑仑 蛛网膜下腔 镇静 

分 类 号：R614.4[医药卫生—麻醉学] R971.2[医药卫生—外科学]