在BIS目标导向镇静下瑞马唑仑用于蛛网膜下腔阻滞患者的镇静效果  

Sedative efficacy of BIS target-oriented sedation with remazolam in patients under subarachnoid block

作　　者：纪洪波[1] 陈静 王国林 JI Hongbo;CHEN Jing;WANG Guolin(Department of Anesthesiology,Tianjin Baodi Hospital,Tianjin 301800,CHINA)

机构地区：[1]天津市宝坻区人民医院麻醉科,301800 [2]天津医科大学总医院

出　　处：《江苏医药》2022年第5期466-469,473,共5页Jiangsu Medical Journal

摘　　要：目的 观察在脑电双频指数(BIS)目标导向镇静下瑞马唑仑用于蛛网膜下腔阻滞患者的镇静效果。方法 蛛网膜下腔阻滞下行下肢手术患者120例分为四组,每组30例。A、B和C组镇静分别采用静脉滴注瑞马唑仑0.3、0.4和0.5 mg·kg^(-1)·h^(-1),D组镇静采用静脉滴注右美托咪定0.8μg·kg^(-1)·h^(-1)作为对照。麻醉起效10 min后实施以BIS为55~65目标导向的镇静。记录镇静前(T0)和镇静后15 (T1)、30 min(T2)时的HR、MAP、SpO_(2)、Ramsay评分和BIS,评估镇静效果和药物不良反应发生情况。结果 四组T1和T2时HR和MAP均降低,C组T2时MAP低于A、B组(P<0.05)。A、B和C组T2时Ramsay评分高于D组(P<0.05)。B、C组T1和T2时BIS低于A、D组(P<0.05)。A、B和C组镇静起效时间短于D组,C组则更短(P<0.05)。B、C和D组镇静有效率高于A组(P<0.05)。A、B和C组苏醒时间短于D组,A、B组则短于C组(P<0.05)。A、B、C组不良反应发生率低于D组(1.1%vs.43.3%)(P<0.01)。结论 在BIS目标导向镇静下,瑞马唑仑0.4~0.5 mg·kg^(-1)·h^(-1)起效快,停用后苏醒快且不良反应发生率低,适合用于蛛网膜下腔阻滞患者的手术镇静。Objective To observe the sedative efficacy of bispectral index(BIS) target-oriented sedation with remazolam in the patients under subarachnoid block.Methods 120 patients underwent lower extremity surgery under subarachnoid block were divided into 4 groups with 30 cases each.The BIS 55-65 target-oriented sedation was performed with intravenous infusion of remazolam 0.3 mg·kg^(-1)·h^(-1)(group A),remazolam 0.4 mg·kg^(-1)·h^(-1)(group B),remazolam 0.5 mg·kg^(-1)·h^(-1)(group C) or dexmedetomidine 0.8 μg·kg^(-1)·h^(-1)(group D),which started at 10 minutes after anesthesia took effect.The HR,MAP,SpO_(2),Ramsay score and BIS were recorded at the time points of before sedation(T0) and 15 minutes(T1) and 30 minutes(T2) during sedation.The sedation efficacy and adverse responses were evaluated.Results The HR and MAP of four groups were lower at T1 and T2 than those at T0(P<0.05).MAP at T2 was lower in group C than that in groups of A and B(P<0.05).Ramsay score at T1 was higher in groups of B and C than that in groups of A and D(P<0.05),which at T2 was higher in groups of A,B and C than that in group D(P<0.05).BIS value at T1 and T2 in groups of B and C was lower than that in groups of A and D(P<0.05),which at T1 was lower in group C than that in group B(P<0.05).The onset time of sedation was shorter in groups of A,B and C than that in group D,which of group C was even shorter than that of groups of A and B(P<0.05).The sedation effectiveness rate was higher in groups of B,C and D than that in group A(P<0.05).The wake up time of groups of A,B and C was shorter than that of group D(P<0.05),which of groups of A and B was shorter than that of group C(P<0.05).The incidence of adverse responses in rimazolam groups was lower than that in group D(1.1% vs.43.3%)(P<0.01).Conclusion The BIS target-oriented sedation with remazolam 0.4-0.5 mg·kg;· h;starts quickly, awakens rapidly with lower incidence of adverse responses, which is suitable for the sedation of surgical patients under subarachnoid block.

关 键 词：瑞马唑仑 脑电双频指数 蛛网膜下腔阻滞 

分 类 号：R614[医药卫生—麻醉学]