咪达唑仑、异丙酚及右美托咪定用于椎管内麻醉辅助镇静时顺行性遗忘作用的比较  

Comparison of anterograde amnesia produced by midazolam, propofol and dexmedetomidine when used to supplement sedation during neuraxial anesthesia

作　　者：赵艾华[1] 李亚南[2] 刘祥[3] 张琦[2] 信茜[2] 王秋筠[2] 王秀丽[2] 霍树平[2] 

机构地区：[1]河北医科大学第四医院麻醉科,石家庄市050019 [2]河北医科大学第三医院麻醉科,石家庄市050051 [3]河北省儿童医院麻醉科,石家庄市050030

出　　处：《中华麻醉学杂志》2017年第4期458-460,共3页Chinese Journal of Anesthesiology

基　　金：河北省科技支撑项目（14277750D）

摘　　要：目的比较咪达唑仑、异丙酚及右美托咪定用于椎管内麻醉辅助镇静的顺行性遗忘作用。方法择期椎管内麻醉下行下肢手术患者60例，性别不限，年龄18～50岁，体重指数23～26 kg/m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其分为3组（n＝20）：咪达唑仑组（M组）、异丙酚组（P组）和右美托咪定组（D组）。于麻醉平面（控制在T10以下）固定时，M组静脉注射咪达唑仑负荷剂量0.05 mg/kg，P组静脉注射异丙酚负荷剂量0.4 mg/kg，D组静脉注射右美托咪定负荷剂量0.6 μg/kg。术中调节3种药物输注速率，维持BIS值82～86。于给药后警觉/镇静评分达3或4分时行遗忘测试。记录术中低血压、窦性心动过缓和呼吸抑制发生情况。结果与M组比较，P组和D组完全遗忘发生率降低（P〈0.05）；P组和D组完全遗忘发生率比较差异无统计学意义（P〉0.05）。3组患者未见低血压、心动过缓和呼吸抑制发生。结论咪达唑仑用于椎管内麻醉辅助镇静时顺行性遗忘作用优于异丙酚和右美托咪定。Objective To compare the anterograde amnesia produced by midazolam, propofol and dexmedetomidine when used to supplement sedation during neuraxial anesthesia.Methods Sixty patients of both sexes, aged 18-50 yr, with body mass index of 23-26 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective operation on lower limbs with neuraxial anesthesia, were divided into 3 groups（n=20 each）using a random number table： midazolam group（group M）, propofol group（group P）and dexmedetomidine group（group D）. When the height of anesthesia was kept below T10, midazolam in a loading dose of 0.05 mg/kg was intravenously injected in group M, propofol in a loading dose of 0.4 mg/kg was intravenously injected in group P, and dexmedetomidine in a loading dose of 0.6 μg/kg was intravenously injected in group D. The infusion rate of the 3 drugs was adjusted to maintain bispectral index value at 82-86.When Observer′s Assessment of Alertness/Sedation Scale scores achieved 3 or 4 after administration, anterograde amnesia was measured by postoperative recall of cards.The development of intraoperative hypotension, bradycardia and respiratory depression was recorded.Results Compared with group M, the incidence of global amnesia was significantly decreased in P and D groups（P〈0.05）. There was no significant difference in the incidence of global amnesia between group P and group D（P〉0.05）. No patients developed hypotension, bradycardia or respiratory depression in three groups.Conclusion Midazolam produces better anterograde amnesia than propofol and dexmedetomidine when used to supplement sedation during neuraxial anesthesia.

关 键 词：咪达唑仑 二异丙酚 右美托咪啶 遗忘 顺行性 

分 类 号：R614[医药卫生—麻醉学]