比较右美托咪定和咪唑安定对焦虑患者记忆功能的影响  

Comparison of the effects of dexmedetomidine and midazolam on memory in patients with anxiety

作　　者：韩智晓[1] 傅艳妮[1] 何波[1] 张昆[1] 李玉娟[1] 

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广州510120

出　　处：《岭南现代临床外科》2014年第3期301-304,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省自然科学基金(编号:S2013010016207)

摘　　要：目的比较右美托咪定和咪唑安定对焦虑患者记忆功能的影响。方法 60例择期在腰硬联合麻醉下行下腹部或下肢手术且焦虑评分>30 mm的患者,随机等分为4组(n=15):右美托咪定(dexmedetomidine,DXM)0.5μg·Kg-1组(D0.5组)、右美托咪定1μg·Kg-1组(D1组)、咪唑安定组(M组)和对照组(C组)。各组分别在L2/3间隙穿刺麻醉,麻醉平面固定后,分别于10min内泵注DXM 0.5μg·Kg-1、DXM 1μg·Kg-1、咪唑安定0.07 mg·Kg-1和生理盐水10 mL。评估各组患者术前及用药前、用药后30 min的焦虑、镇静程度及记忆情况以及手术结束后4小时的记忆情况。记录并比较4组患者术中的平均压(MBP)、心率(HR)、血氧饱和度(SpO2)、呼吸次数(RR)等。结果D0.5、D1及M组用药后均有一定程度的镇静作用,焦虑程度均较术前明显减轻(P<0.05)。与对照组相比,D0.5、D1、M组均有顺行性遗忘作用(P<0.05),D1组顺行性遗忘程度明显高于D0.5组(P<0.05),与M组相当(P>0.05)。用药后D0.5、D1组MBP和HR低于M、C组(P<0.05)。各组RR无明显差异(P>0.05),而M组有2人SpO2下降至94%以下。结论右美托咪定对焦虑患者有明显的镇静、抗焦虑作用,对记忆的影响与剂量有关。1μg·Kg-1右美托咪定的顺行性遗忘作用与咪唑安定0.07 mg·Kg-1相当。Objective To compare the effects of dexmedetomidine and midazolam on memory in patients with anxiety. Methods Sixty patients with Anxiety Visual Analog Test （AVAT）〉30 mm, ASA Ⅰ or Ⅱ, who were scheduled for hypogastrium and lower limbs surgery under combined spinaleunder anesthesia were randomly divided into four groups （n= 15, each group） ： dexmedetomidine （DXM） 0.5μg·Kg^-1 group （group D0.5）, DXM 1 μg·Kg^-1 group （group D1）, midazolam group （group M） and saline group （group C）. After spinal anesthesia in L2/3, patients were infused intravenously with dexmedetomidine at 0.5μg·Kg^-1 in Group D0.5,1μg·Kg^-1 in group D1, midazolam at 0.07 mg·Kg^-1 in group M and saline 10 ml in group C over 10 minutes. AVAT, Rasmay score and memory function were evaluated at preoperation, before and thirty minutes after drug infusion. Memory function were evaluated again 4 hours after operation. Mean blood pressure （MBP）, heart rates （HR）, SpO2, respiratory rates （RR）of patients during operation were recorded. Results Patients in groups of D0.5, D1 and M had significant sedation and decrease in anxiety after drug infusion when compared to preoperation （P〈0.05 for all groups）, and also had anterograde amnesia effect compared to group C （P〈 0.05 for all groups）. The degree of anterograde amnesia in group D1 was significantly higher in group D1 than that in group D0.5 （P〈0.05）, but was the same to that in group M（P〉0.05）. MBP, HR in groups of D0.5 and D1 were lower than those in group M and group C. The respiratory rates had no significant difference among all groups. However, two patients in group M had a decrease in SpO2 below 94%. Conclusion Dexmdetomidine has significant effects on antianxiety and sedation, and has an anterograde amnesia in patients with anxiety. The degree of anterograde amnesia at dexmedetomidine 1 μg·Kg^-1 has the same effect as 0.07 mg· Kg^-1 of midazolam.

关 键 词：右美托咪定 咪唑安定 焦虑 记忆 

分 类 号：R614[医药卫生—麻醉学]