咪达唑仑在肺癌合并肺气肿手术患者中的麻醉效果  

Anesthetic efficacy of midazolam in patients with lung cancer complicated with emphysema undergoing surgery

作　　者：朱珊[1] 张艳梅 曹汉忠[1] 王浩然[1] 刘雷[2] 张慧[3] 康培培[1] Zhu Shan;Zhang Yan-mei;Cao Han-zhong;Wang Hao-ran;Liu Lei;Zhang Hui;Kang Pei-pei(Department of Anesthesiology,Nantong Tumor Hospital,Nantong 226000,China;Department of Thoracic Surgery,Nantong Tumor Hospital,Nantong 226000,China;Department of Laboratory Tests,Nantong Tumor Hospital,Nantong 226000,China)

机构地区：[1]南通市肿瘤医院麻醉科,南通226000 [2]南通市肿瘤医院胸外科,南通226000 [3]南通市肿瘤医院检验科,南通226000

出　　处：《中国药物应用与监测》2024年第6期764-767,共4页Chinese Journal of Drug Application and Monitoring

基　　金：南通市卫生健康委员会科研课题(QNZ2022029)。

摘　　要：目的观察咪达唑仑在肺癌合并肺气肿手术患者中的应用效果。方法选取南通市肿瘤医院2023年1月至2023年12月间收治的肺癌合并肺气肿患者195例,通过随机数字表法分为对照组(n=97)、咪达唑仑组(n=98)。对照组采用0.5μg·kg^(-1)舒芬太尼、0.15 mg·kg^(-1)苯磺顺阿曲库铵、丙泊酚1 mg·kg^(-1)进行麻醉诱导,气管插管行机械通气后,静脉泵注0.1 mg·(kg·h)^(-1)丙泊酚、0.3μg·(kg·h)-1瑞芬太尼、0.15 mg·kg^(-1)苯磺顺阿曲库铵维持麻醉。咪达唑仑组麻醉诱导在对照组用药基础上加用0.05 mg·kg^(-1)咪达唑仑。比较两组麻醉开始时(T0)、脑电双频指数(BIS)<75(T_(1))、插管后(T_(2))的心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)水平。比较两组患者术前、术后1 d认知功能、炎症因子水平。观察术后不良反应发生情况。结果两组患者HR逐渐升高,咪达唑仑组低于对照组;两组MAP先降低后升高,对照组变化幅度大,咪达唑仑组变化幅度小,两组HR、MAP组间、时间以及交互比较差异均有统计学意义,两组SpO_(2)交互比较,差异无统计学意义(F交互=5.025,3.841,0.314,均P<0.05)。术后1 d,两组患者蒙特利尔认知评估量表评分均下降,且咪达唑仑组[(24.98±0.92)分]高于对照组[(23.78±0.82)分](t=9.611,P<0.05)。两组血清肿瘤坏死因子α、白细胞介素1β、白细胞介素6、重组人趋化因子8水平均升高,且对照组[分别是(18.65±3.16)pg·mL^(-1)、(16.17±3.18)pg·mL^(-1)、(26.33±4.21)pg·mL^(-1)、(73.28±11.65)ng·mL^(-1)]高于咪达唑仑组[分别是(15.31±2.83)pg·mL^(-1)、(11.36±2.58)pg·mL^(-1)、(18.79±3.93)pg·mL^(-1)、(67.42±10.17)ng·mL^(-1)],差异均有统计学意义(t=7.777,11.604,12.929,3.743,均P<0.05)。两组不良反应发生率(5.10%vs 8.24%),差异无统计学意义(χ^(2)=0.775,P>0.05)。结论咪达唑仑对肺癌合并肺气肿手术患者进行麻醉处理具有更好的麻醉效果,可减小对患者血流动力学�Objective To observe the efficacy of midazolam in patients with lung cancer complicated with emphysema.Methods A total of 195 patients with lung cancer complicated with emphysema admitted to Nantong Tumor Hospital from January 2023 to December 2023 were divided into the control group(n=97)and midazolam group(n=98)by random number table method.In the control group,anesthesia was induced by 0.5μg·kg^(-1)sufentanil,0.15 mg·kg^(-1)benzoatracurium sulfonate,and 1 mg·kg^(-1)propofol.After mechanical ventilation with tracheal intubation,0.1 mg·(kg·h)^(-1)propofol and 0.3μg·(kg·h)^(-1),0.15 mg·kg^(-1)benzoatracurium sulfonate remifentanil were injected intravenously to maintain anesthesia.In the midazolam group,0.05 mg·kg^(-1)midazolam was used on the basis of the regimen in the control group.The heart rate(HR),oxygen saturation(SpO_(2))and mean arterial pressure(MAP)levels were compared at the beginning of anesthesia(T0),BIS<75(T1)and after intubation(T_(2)).The cognitive function and inflammatory factor levels were compared before and 1 d after operation between the two groups.The occurrence of postoperative adverse reactions was observed.Results HR increased gradually in both groups,and it was lower in the midazolam group than in the control.MAP decreased firstly and then increased in the two groups,with the largest change in the control group and the smallest change in the midazolam group.There were significant differences in HR,MAP,time and interaction between the two groups,and no difference in SpO_(2)interaction between the two groups(F=5.025,3.841,0.314,all P<0.05).One day after surgery,the Montreal Cognitive Assessment Scale scores decreased in both groups,and they were higher in the midazolam group((24.98±0.92)points)than in the control group((23.78±0.82)points)(t=9.611,P<0.05).Serum tumor necrosis factor-α,interleukin-1β,interleukin-6,and recombinant human chemokine 8 levels were elevated in both groups and they were higher in the control group((18.65±3.16)pg·mL^(-1),(16.17±3.18)pg·mL^(-1),(

关 键 词：咪达唑仑 肺癌 肺气肿 效果 不良反应 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]