咪唑安定-芬太尼-异丙酚顺序静注诱导对患者镇静程度和麻醉深度的影响  

Effect of midazolam-fentanyl-propofol given intravenously in sequence on level of sedation and depth of anesthesia

作　　者：许学兵[1] 佘守章[1] 阎焱[1] 董源洪[1] 许立新[1] 

机构地区：[1]广州市第一人民医院麻醉科,510180

出　　处：《中华麻醉学杂志》2002年第3期140-142,共3页Chinese Journal of Anesthesiology

摘　　要：目的 研究咪唑安定（Mid）-芬太尼（Fen）-异丙酚（Pro）顺序静注诱导对患者镇静程度、听觉诱发电位指数（AEPindex）、脑电双频谱指数（BIS）和血流动力学的影响。方法 40例（ASA　I-Ⅱ）听力正常患者,采用Mid-Fen-Pro顺序诱导,监测记录诱导前基础值（T0）、静注Mid 0.06mg/kg后1、3、5min（T1、T2、T3）、静注 Fen 4mg/kg后1、3、5min（T4、T5、T6）以及静注Pro后1、3min（T7、T8）等时点AEPindex、BIS、MAP和HR值,并同时行改良OAA/S镇静评级。结果 静注Mid后1～5min患者OAA/S评级迅速下降,37.5％患者意识消失;AEPindex、BIS、MAP值也逐渐下降（与T0相比,P<0.01）。静注Fen后MAP继续下降（T4～6与T0～3相比,P<0.05～0.01）,HR显著下降（T4～6与T3相比,P<0.01）;此期间患者OAA/S评级下降,但AEPindex、BIS无明显变化（T4～6与T3相比,P>0.05）。应用Pro后3min,所有患者OAA/S均降为0;AEPindex、BIS分别降至（28.97±11.03）,（50.38±11.89）,MAP也明显下降（T7、T8与T0～6相比,P<0.05～0.01）。结论Mid-Fen-Pro联合诱导能平稳地诱导麻醉,诱导期间AEPindex,BIS均能准确地反映临床镇静麻醉深度。Objective To assess the effects of midazolam-fentanyl-propofol given intravenously in sequence on auditory evoked potential (AEP) index, BIS, OAA/S score, blood pressure(BP) and HR. Methods Forty ASA I-Ⅱ patients with normal hearing (19 male, 21 female) scheduled for elective surgery under general anesthesia were enrolled in this study. Age ranged from 10-80(51.6±11.3)yr and body weight 26-77(57.6±9.12)kg. Premedication consisted of phenobarbital 0.1-0.2g and scopolamine 0.3mg. The depth of anesthesia was monitored by AEP index , BIS and modified OAA/S sedation score(5 = respond quickly when the patient's name is called; 0 = no response when the patient's trapezius muscle is pinched). Anesthesia was induced with midazolam 0.06 mg· kg-1, fentanyl 4 μg·kg-1 and propofol 0.5mg·kg-1 given IV in sequence with an interval of 5 min between two injections. AEP index, BIS and OAA/ S score were monitored and recorded before induction(T0), at 1, 3, 5, min after midazolam(T1-3), 1, 3, 5, min after fentanyl ( T4-6) and 1, 3min after propofol ( T7-8 ). Results (1) After intravenous midazolam injection OAA/S score decreased quickly and 37.5% of the patients became unconscious. AEP index and BIS also gradually decreased. (2) After fentanyl IV injection OAA/S score continued decreasing but there was little change in AEP index and BIS ( P > 0.05 as compared with T3 ) . (3) 3 min after propofol injection OAA/S score dropped to 0 in all patients; AEP index and BIS decreased to 28.97±11 and 50± 11 respectively.Conclusions Induction of anesthesia with intravenous midazolam-fentanyl-propofol is smooth and effective with little circulatory disturbance.

关 键 词：咪达唑仑 芬太尼 二异丙酚 清醒镇静 麻醉深度 

分 类 号：R614.24[医药卫生—麻醉学]