异丙酚和咪达唑仑靶控输注用于硬膜外麻醉病人术中镇静的对比研究_医学论文.docVIP

异丙酚和咪达唑仑靶控输注用于硬膜外麻醉病人术中镇静的对比研究_医学论文 异丙酚和咪达唑仑靶控输注用于硬膜外麻醉病人术中镇静的对比研究_医学论文 【关键词】 靶控输注麻醉,硬膜外异丙酚咪达唑仑脑电描记术清醒镇静 　　［摘要］目的 观察异丙酚和咪达唑仑靶控输注（TCI）用于硬膜外麻醉病人术中镇静的效果，为临床工作提供指导。方法 下腹部手术病人40例，ASA Ⅰ～Ⅱ级，随机分成两组，每组20例。Ⅰ组为硬膜外麻醉复合TCI异丙酚组，Ⅱ组为硬膜外麻醉复合TCI咪达唑仑组。硬膜外麻醉效果满意后开始TCI，利用警觉-镇静（OAA/S）评分和脑电双频指数（BIS）监测镇静程度，OAA/S评分发生变化时记录即刻的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2 ）、BIS及血药浓度。术中保持OAA/S评分于3分水平，如病人出现躁动则加深至2分。术中监测不良反应，手术结束前停TCI，观察苏醒时间。结果 不同OAA/S评分时两组病人MAP、HR、SpO 2 、BIS均有明显改变，组间比较无显著差异。两组病人不良反应发生率无明显差异。苏醒时间Ⅰ组短于Ⅱ组（ t=5.15， P lt 0.01 ）。OAA/S评分与BIS呈正相关（ r=0.829、0.871，P lt0.01），BIS与血药浓度呈负相关（ r=-0.771、 -0.687 ，P lt0.01）。结论 异丙酚和咪达唑仑靶控输注用于硬膜外麻醉病人的术中镇静安全有效，BIS与OAA/S评分可有效指导TCI用药，值得临床推广。 　　 　　［关键词］ 靶控输注麻醉，硬膜外异丙酚咪达唑仑脑电描记术清醒镇静 　　［ABSTRACT］ObjectiveTo compare target controlled infusion（TCI） with propofol and midazolam for sedation in patients undergoing epidural anesthesia and to provide instruction of clinical application. MethodsForty patients undergoing lower-ab-dominal operation under epidural anesthesia were randomly divided into two equal groups. Group Ⅰ combined TCI with propofol Group Ⅱ with midazolam only. After anesthesia， TCI was executed. OAA/S score and BIS were used to monitor sedation of pa-tients. MAP， HR， SpO2 ， BIS and plasma concentration were recorded as OAA/S score changed. OAA/S score was kept on 3 during operation. The score would be reduced to 2 if body moving observed. Adverse reactions were monitored during operation. TCI was stopped before the end of operation and awake time recorded. ResultsThe changes of MAP， HR， SpO2 ， and BIS in different OAA/S score were observed in the two groups， but no significant difference found between them. The adverse reactions were not different between two groups. Awake time of Group Ⅰ was significantly shorter than Group Ⅱ （ t=5.15，P lt0.05）.There was a positive correlation between OAA/S score and BIS ，and negative correlation between BIS and plasma concentration. ConclusionTCI with propofol and midazolam for sedation in patients undergoing epidural anest