咪达唑仑复合舒芬太尼硬膜外麻醉对行腹腔镜阑尾切除术患者术中内脏牵拉反应及镇静效果的影响

摘要

目的 探讨咪达唑仑复合舒芬太尼硬膜外麻醉对行腹腔镜阑尾切除术患者术中内脏牵拉反应及镇静效果的影响.方法 选取2014年1 1月至2016年10月在本院进行腹腔镜阑尾切除术患者67例,按照随机数字表法分为两组,对照组33例予以单一舒芬太尼硬膜外麻醉,观察组34例予以舒芬太尼+咪达唑仑硬膜外麻醉,观察比较两组镇静效果(镇静起效时间、镇静持续时间)及对患者内脏牵拉反应的影响,并统计两组不良反应发生情况.结果 观察组镇静起效时间为(5.28±1.12) min,小于对照组(11.36±2.94) rin,镇静持续时间为(3.50±0.29)h,大于对照组(1.44±0.35)h,差异有统计学意义(t1=1 1.249,t2=26.266,P1=0.000,P2=0.000);观察组内脏牵拉反应较对照组轻微,差异有统计学意义(P＜0.05);观察组不良反应发生率为17.65％(6/34),对照组为12.12％(4/33),组间比较差异无统计学意义(x2=0.085,P=0.771).结论 咪达唑仑复合舒芬太尼硬膜外麻醉应用于行腹腔镜阑尾切除术患者,镇静效果显著,可有效缓解腹腔镜阑尾切除术患者术中内脏牵拉反应,且安全性高.%Objective To investigate the influence ofepidural anesthesia with midazolam and sufentanil on intra-operative visceral traction and sedation in patients undergoing laparoscopic appendectomy.Methods 67 patients undergoing laparoscopic appendectomy at hospital from November,2014 to October,2016 were selected and randomly divided into a control group (n=33) and an observation group (n=34).The control group undertook epidural anesthesia with sufentanil and the observation group with sufentanil and midazolam.The sedation effect (sedation onset time,sedation duration) and the effect on the visceral traction response were observed and compared between the two groups.The incidences of adverse reactions in the two groups were statistically analyzed.Results The sedation onset time was shorter and the sedation duration were longer in the observation group than in the control group [(5.28±1.12) min vs.(11.36±2.94) min and (3.50±0.29) h vs.(1.44±0.35) h],with statistical differences (t1=1 1.249,t2=26.266,P1=0.000,P2=0.000).The visceral traction response is milder in the observation group than in the control group,with a statistical difference (P ＜ 0.05).The incidence of adverse reactions was 17.65％ (6/34) in the observation group and was 12.12％ (4/33) in the control group,with no statistical difference (x 2=0.085,P=0.771).Conclusion Epidural anesthesia with midazolam and sufentanil for patients undergoing laparoscopic appendectomy has significant sedation effect,can effectively relieve the patients' visceral traction reaction,and is highly safe.