咪唑安定和芬太尼对麻醉中老年高血压患者的降压作用  

Effect of Midazolam and Fentanyl on Hypertension in Senile Hypertensive Patients

作　　者：梁韶军[1] 杨永慧[1] 张凤林[1] 蒯建科[1] 

机构地区：[1]第四军医大学唐都医院全军骨肿瘤研究所,陕西西安710038

出　　处：《中国医师杂志》2002年第6期618-620,共3页Journal of Chinese Physician

摘　　要：目的　探讨镇静药物咪唑安定与芬太尼的临床降压作用。方法　 38例老年高血压患者 ,术中使用将咪唑安定 (0 2mg/kg)与芬太尼 (2 μg/kg) ,观察给药前后的BP、HR、心电ST段和PETCO2 等变化 ,并将给药前后的各项参数值进行统计学分析。结果　给药前后SAP、MAP、DAP、HR及RPP等参数均呈现较为一致的规律性变化 :注药前 5min的各项参数较术前 2 4h所测参数有显著的升高 (P <0 0l) ;而注药后l5min各参数又显著下降 ,与术前 2 4h和注药前 5min均有显著差异 (P <0 0 5 ) ;在随后的注药后 30、6 0min时 ,各参数保持平稳 ,与l5min时相比无显著差异 (P >0 0 5 ) ;直至注药后 12 0min时 ,各项参数与 6 0min时相比有回升的趋势 (P <0 0l) ,但与术前 2 4h相比 ,除HR外各参数仍末达到术前 2 4h水平。实测 12导联同步心电图ST段自动分析 ,所有患者在降压的过程中未见病理改变或已有的病理改变加重的趋势。对PETCO2 的观察发现 ,38例患者在给药后均有因深睡而引起不同程度的呼吸减弱、二氧化碳蓄积或舌下坠 ,如麻醉中不加吸氧或辅助通气 ,PETCO2 有超过 5 0mmHg的趋势。结论　在避免痛疼及强制性唤醒刺激 ,并且注重呼吸管理的情况下 ,咪唑安定与芬太尼后配伍使用有确定的降压和改善心肌氧耗的作用 。Objective To observe the effects of midazolam and fentanyl on hypertension in senile hypertensive patients.Method 38 cases with moderate primary hypertension were received midazolam and fentanyl during operation .BP,HR,P ET CO 2 and the change of ST segment from the 12-lead simultaneous ECGs were measured and compared respectively. Results Some parameters ,such as BP,HR,RPP have a parallel change during experimental period . There were significant differences in BP,HR,RPP at 5 min before administration then at the time in ward(P<0 0l).There were reduced significantly in BP,HR,RPP at 15 min after administration then at 5 min before administration and at the time in ward(P<0 0l). Here after these parameters were steady in 30 and 60 min after administration and there were no significant differences then at 15 min after administration(P>0 05). Nearly to reach 120 min after administration, the parameters tend to become uplifted as compared with in 30 and 60 min after administration(P<0 0l), but apart from HR, the parameters do not restitute to the level in ward(P<0 0l). On the other hand, it is not any further pathologic change to the ST segment from the 12-lead simultaneous ECGs during experimental period, but because the sound sleep caused by the dugs, all patients have a symptom of hypopnea and CO 2 accumulation. Conclusions If patients are assured no pain and no hypopnea during intraoperative period, midazolam and fentanyl will have an affirmative effect in the control of blood pressure in senile patients with hypertension.

关 键 词：麻醉 静脉 咪唑安定 芬太尼 高血压 老年 

分 类 号：R544.1[医药卫生—心血管疾病]