右美托咪定和咪达唑仑用于腰硬联合麻醉中清醒镇静的效果对比

摘要

Objective To compare effect of dexmedetomidine and midazolam on calming of awaken patients in combined spinal and epidural analgesia.Methods A total of 110 patients underwent abdominal operation in combined spinal epidural anesthesia in our hospital were randomly divided into dexmedetomidine group (n =17) and midazolam group (n =18),given dexmedetomidine 0.7 μg/kg and midazolam 0.07 mg/kg by venous pump,respectively.Vital signs and sedation indicators before administration,10 min after administration,10 min after anesthesia,0.5 h after skin incision,at the completion of operation and degree of forgetting,respiratory inhibition rate of patients in two groups were compared.Results Compared to patients before administration,patients in the dexmedetomidine group and midazolam group had lower mean arterial pressure,bispectral index,AVA/SAI score and alertness/sedation score,and dexmedetomidine group had lower heart rate at 10 min after administration,10 min after anesthesia,0.5 h after skin incision,at the completion of operation (P ＜ 0.05).Compared to midazolam group,patients in the dexmedetomidine group had slower heart rate,lower alertness/sedation score (P ＜ 0.05).And patients in the dexmedetomidine group had lower forgetting rate in Ⅰ,Ⅱ degree and higher rate of Ⅲ degree(P ＜0.01).No respiratory depression occurred in patients of two groups.Conclusion Dexmedetomidine and midazolam can relieve tension and anxiety of patients in combined spinal epidural anesthesia and sedation effect of dexmedetomidine is better but need to pay attention to its effect on heart rate.%目的 对比右美托咪定和咪达唑仑用于腰硬联合麻醉中清醒镇静的效果.方法 选取本院行腰硬联合麻醉下腹部手术患者35例,随机分为右美托咪定组(n=17)与咪达唑仑组(n=18)分别予右美托咪定0.7 μg,/kg、咪达唑仑0.07 mg/kg静脉泵入.比较2组患者给药前、给药后10 min、麻醉后10 min、切皮后0.5h、手术完成时生命体征及镇静指标,术后遗忘程度分级及呼吸抑制发生率.结果 与给药前相比,右美托咪定组与咪达唑仑组患者给药后10 min、麻醉后10 min、切皮后0.5h、手术完成时平均动脉压、脑电双频指数、AVA/SAI评分、警觉/镇静评分较低,右美托咪定组患者心率较慢(P＜0.05);与咪达唑仑组相比,右美托咪定组患者给药后10 min、麻醉后10 min、切皮后0.5h、手术完成时心率较慢,警觉/镇静评分较低(P＜0.05),且右美托咪定组患者遗忘程度分级Ⅰ、Ⅱ级率较低,Ⅲ级率较高(P＜0.01).2组患者均未发生呼吸抑制.结论 右美托咪定和咪达唑仑用于腰硬联合麻醉前均可缓解患者紧张、焦虑情绪,而右美托咪定清醒镇静效果更好,但需注意其对心率的减慢作用.