目的比较在脑电双频指数监测下咪达唑仑和丙泊酚做为硬膜外静脉辅助用药时，起效时间，恢复时间，使用剂量及不良反应的发生率。方法78例择期下肢手术患者，ASA分级I～Ⅱ级，随机分为咪达唑仑组（M组）和丙泊酚组（P组），硬膜外麻醉完善后分别恒速输注0.1%的咪达唑仑和1%丙泊酚注射液，然后分别记录两组患者达到预期镇静深度的时间，用药剂量，恢复时间，静脉用药总量，平均动脉压（MABP），心率（HR），脉搏血样饱和度（SpO2），呼吸频率（RR），不良反应（术中知晓，注射痛，烦躁，恶心呕吐）发生率。结果达到预期镇静深度的时间M组和P组分别为11.0±3.66（min）、6.2±1.88（min）。恢复时间M组和P组分别为18.6±6.50（min）、10.1±3.65（min），M组长于P组。平均动脉压（MABP）较基础值波动＞20%M组2例（5.3%），P组11例（28.9%）。需面罩加压给氧，M组11例（28.2%）P组8例（20.5%）。不良反应两组间差异无统计学意义。结论作为硬膜外麻醉静脉辅助用药时，咪达唑仑和丙泊酚均能达到预期的镇静深度，丙泊酚起效和恢复时间均较咪达唑仑短，但血流动力学变化较咪达唑仑剧烈。%Objective To compare sedative effects of Midazolam and Propofol for BIS-Guided sedation during epidural anesthesia. Method 78 cases of patients with selected time operation of lower limbs under epidural anesthesia, ASAI-Ⅱ, randomized to Midazolam group (Group M)and Propofol group (Group P). We observed Time to reach desired sedation, recovery, dose to reach sedation and for maintenance of sedation, MABP, HR, SpO2, RR, side effects. Results The time to reach the required level of sedation in Group M was 11.0±3.66 minutes which later than Group P 6.0±1.88 minutes (P=0.00). The time for recovery in Group M 18.6±6.50 minutes was longer than Group P 10.01±3.65 minutes (P=0.00).A decrease of MABP>20%from baseline was seen in 2(5.3%) in Group M, and in 11(28.9%) in Group P. Oxygen was provided when SpO2 level was below 90 or RR was below10, it was seen 11 (28.2%) patients in Group M as compared to 8 (20.5%) in Group P (P<0.05).The differences of side effects in the two groups was statistically not signiifcant. Conclusions This study showed that though both midazolam and propofol are effective sedative agents, the time to reach effective sedation was less with propofol than midazolam and similarly the time to recovery time from sedation was lesser with propofol. Propofol caused a greater fall in MABP, thus providing less haemodynamic stability than midazolam.
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