咪达唑仑与右美托咪定对老年妇科肿瘤手术患者镇静效果及呼吸动力学的影响  

Effects of midazolam and dexmedetomidine on sedation and respiratory dynamics in elderly patients undergoing gynecological tumor surgery

作　　者：梁第杰 梁开远[1] 李泽均[1] Liang Dijie;Liang Kaiyuan;Li Zejun(Department of Anesthesiology,Guigang People’s Hospital,Guigang 537100)

机构地区：[1]贵港市人民医院麻醉科,广西贵港537100

出　　处：《中国现代医药杂志》2022年第2期21-25,共5页Modern Medicine Journal of China

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题项目(编号:Z20200546)。

摘　　要：目的探讨咪达唑仑与右美托咪定对老年妇科肿瘤手术患者呼吸动力学及镇静效果的影响。方法选取我院2019年12月~2021年5月接受老年妇科肿瘤开腹手术患者140例,采用单双数法分为咪达唑仑组和右美托咪定组,各70例。咪达唑仑组在基础麻醉上予50mg/100ml咪达唑仑稀释液,以0.1mg·kg^(-1)·h^(-1)持续泵入;右美托咪定组在基础麻醉上予1mg/100ml右美托咪定稀释液,以0.1μg·kg^(-1)·h^(-1)持续泵入。比较两组患者拔管时间、苏醒时间、应答时间、Ramsay镇静评分、Riker镇静-躁动评分及躁动发生率;观察两组患者手术开始10min(T1)、手术开始30min(T2)、手术结束前10min(T3)3个时间点的肺动态顺应性(CLD)、气道峰压(Ppeak)、呼气末二氧化碳分压(PETCO2)变化情况。结果与咪达唑仑组比较,右美托咪定组患者拔管时间、苏醒时间及应答时间缩短(P<0.05),Ramsay镇静评分、Riker镇静-躁动评分升高(P<0.05),躁动发生率及不良反应发生率降低(P<0.05);两组呼吸动力学CLD、Ppeak及PETCO2指标均有明显差异(P<0.05)。结论咪达唑仑与右美托咪定对老年妇科肿瘤手术患者均具有较好的镇静作用,右美托咪定镇静效果更佳,且对呼吸动力学指标影响较小,药物不良反应发生率更低。Objective To investigate the effects of midazolam and dexmedetomidine on respiratory dynamics and sedation in elderly patients undergoing gynecological tumor surgery.Methods 140 elderly patients with gynecological tumors who underwent open surgery in our hospital from Dec 2019 to May 2021 were divided into midazolam group and dexmedetomidine group by single and double number method,70 cases in each group.In midazolam group,50 mg/100 ml midazolam diluent was continuously pumped at 0.1 mg·kg^(-1)·h^(-1) on the basis of basic anesthesia.Dexmedetomidine group was continuously pumped with 1 mg/100 ml dexmedetomidine diluent at 0.1μg·kg^(-1)·h^(-1) on the basis of basic anesthesia.The extubation time,recovery time,response time,Ramsay sedation score,Riker sedation-agitation score and incidence of agitation were compared between the two groups.The changes of dynamic lung compliance(CLD),peak airway pressure(Ppeak)and end-tidal carbon dioxide partial pressure(PETCO2)were observed at three time points:10 min after the operation(T1),30 min after the operation(T2)and 10 min before the end of the operation(T3).Results Compared with midazolam group,the extubation time,recovery time and response time of dexmedetomidine group were shorter(P<0.05),Ramsay sedation score and Riker sedationagitation score were higher(P<0.05),and incidence of agitation and adverse reactions were lower(P<0.05).There were significant differences on CLD,Ppeak and PETCO2 in respiratory dynamics between the two groups(P<0.05).Conclusion Midazolam and dexmedetomidine have better sedative effects on elderly patients undergoing gynecological tumor surgery.Dexmedetomidine has better sedative effect,less effect on respiratory dynamics,and has a lower incidence of adverse drug reactions.

关 键 词：咪达唑仑 右美托咪定 呼吸动力学 镇静 躁动 

分 类 号：R614[医药卫生—麻醉学] R737.3[医药卫生—外科学]