无持续剂量的咪达唑仑自控镇静在冠状动脉支架术中的应用  

Midazolam with and without background dose of patient-controlled sedation during percutaneous transluminal coronary angioplasty and stenting

作　　者：杨改生[1] 陈延英[1] 薛晓东[1] 

机构地区：[1]空军总医院麻醉科,北京100142

出　　处：《空军医学杂志》2014年第1期44-47,共4页Medical Journal of Air Force

摘　　要：目的观察无持续剂量和有持续剂量两种不同方法的咪达唑仑患者自控镇静(PCS)在冠状动脉支架术中的作用。方法选择拟行冠状动脉支架术患者60例,随机均分为3组:持续剂量+单次剂量(Bolus)组(A组,n=20)、无持续剂量的Bolus组(B组,n=20)和无镇静对照组(C组,n=20)。A组和B组在实施局麻前分别使用咪达唑仑进行两种不同方法的自控镇静:A组PCS设置为持续剂量0.1 mg/(kg·h),Bolus为0.25 mg,锁定时间为3 min;B组PCS设置为无持续剂量,Bolus为0.5 mg,锁定时间为3 min,两组均无负荷剂量。C组在常规局麻无镇静状态下进行冠状动脉支架术。术中持续检测ECG、HR、BP、SpO2、患者镇静程度评分及脑电双频谱指数(BIS),并于术前、术中和术后3 h分别采取静脉血测定血浆儿茶酚胺(肾上腺素、多巴胺、去甲肾上腺素)、皮质醇、ACTH水平变化。术后随访患者镇静满意程度和心血管系统并发症情况。结果 3组患者在性别、年龄、心功能、冠脉病变、术前血浆儿茶酚胺、皮质醇、ACTH水平均无显著差异(P>0.05)。术中A组和B组MAP、HR均较C组显著下降(P<0.01),A组和B组之间差异无统计学意义(P>0.05);术中A组SpO2较C组显著下降(P<0.01),B组较C组轻度下降但差异无统计学意义(P>0.05)。A组和B组术中血浆儿茶酚胺、皮质醇和ACTH水平均明显低于C组(P<0.01),A组和B组之间差异无统计学意义(P>0.05),术后3 h 3组间无显著差异。A组(3.9±0.9)和B组(2.5±0.5)镇静评分明显优于C组(1.2±0.42)(均P<0.05);BIS值A组(71.5±10.5)和B组(75.4±10.9)显著低于C组(92.5±3.7)(均P<0.05),A组较B组镇静评分高、BIS值低(均P<0.05),并出现2例镇静过度。结论采用无持续剂量的咪达唑仑进行自控镇静可较好地控制镇静程度,有效降低应激反应,安全有效。ObjectiveWe aimed to observe the safety and effect of patient-controlled sedation（PCS） with midazolam during transluminal percutaneous coronary angioplasty （PTCA） and stenting （CS）.MethodsSixty patients of coronary heart disease （heart function testsⅠ-Ⅱ） were randomly divided into three groups： group A （Midazolam continuous dose 0.1 mg/（kg·h）＋0.25 mg bolus,3-minute lockout,n=20） and group B （Midazolam 0.5 mg bolus only,3-minute lockout,n=20） and group C（control group without any Sedated therapy,n=20）.Neither group A nor group B has loading dose. Heart rates, blood pressure and oxygen saturation were continuously monitored. Level of sedation were scored, Bispectral Idex（BIS）, ACTH and Catecholamine in blood plasma are monitoring in all patients before, during and 3h after the operation. Patients’satisfaction was assessed by questionnaire.ResultsThere were no significant changes of heart rates, blood pressure, oxygen saturation, RPP, level of sedation, BIS, ACTH and catecholamine in blood plasma in all patients before the operation. Heart rates, blood pressure and oxygen saturation in group A decreased more significantly than that in group C during operation（P〈0.01）, heart rates, blood pressure in group B decreased more dramatically than that in group C（P〈0.05） but oxygen saturation were similar in group B and group C. The level of sedation was higher, and BIS was lower in group A and group B than that in group C（P〈0.05）.The levels of ACTH and catecholamine in group A and group B were lower than that in group C （P〈0.05）.There are no significance changes of the level of ACTH and catecholamine between group A and group B. Two patients became over-sedated in group A, compared with none in group B.ConclusionPatient-controlled sedation with midazolam （bolus only） may provide safe and effective sedation during percutaneous transluminal coronary angioplasty and stenting, and reduce the level of stress response.

关 键 词：患者自控镇静 冠状动脉支架术 咪达唑仑 

分 类 号：R614.4[医药卫生—麻醉学]