小剂量咪达唑仑用于剖宫产麻醉前用药对母婴的影响_临床医学论文.docVIP

小剂量咪达唑仑用于剖宫产麻醉前用药对母婴的影响_临床医学论文 小剂量咪达唑仑用于剖宫产麻醉前用药对母婴的影响_临床医学论文 【摘要】 目的 观察硬膜外麻醉前静注小剂量咪达唑仑,对剖宫产产妇的抗焦虑、抗应激反应的影响,以及对新生儿是否有不良影响。 方法 选择单胎足月妊娠产妇80例。根据咪达唑仑用量随机将患者分为四组,每组20例。Mo组为对照组，静注生理盐水2ml；M1组静注咪达唑仑0.01ml/kg、M2组0.02ml/kg、M3组0.03ml/kg。5min之后行硬膜外麻醉。观察记录注药前（T1）、注药后5min（T2）、15min（T3）、30min（T4）产妇的脉搏血氧饱和度（SpO2）、呼吸（RR）、平均动脉压（MAP）、心率（HR）变化。观察注药前、注药后30min（划皮前）产妇焦虑视觉类比试验（AVAT）、血糖、皮质醇变化。观察胎儿娩出后1、5min Apgar评分、术后1d的新生儿神经与适应能力（NACS）评分。结果 四组产妇呼吸循环功能稳定，M3组焦虑视觉类比试验用药后评分下降，血糖、皮质醇低于其他组。四组新生儿1、5min Apgar评分、术后1d的NACS无明显差异。结论 硬膜外麻醉前静注小剂量咪达唑仑, 对剖宫产产妇有良好的抗焦虑及应激反应作用，对新生儿无不良影响。其剂量以0.03mg/kg为宜。 【关键词】 咪达唑仑 剖宫产 术前用药 应激反应 皮质醇 　　【Abstract】 Objective To observe the antianxiety and anti-stress reaction effects of intravenous injection of a small dose of Midazolam on puerperants as preanesthetic medication before epidural anesthesia in uterine-incision delivery operation. Methods 80 puerperants with pregnancy at term and single birthed were randomly divided into 4 groups with 20 each . M0 group as control , intravenous injection of 2ml normal sodium ;in M1 group, intravenous injection of 0.01ml/kg Midazolam; in M2 group, intravenous injection of 0.02ml/kg Midazolam; in M3 group, intravenous injection of 0.03ml/kg Midazolam. Then epidural anesthesia was performed 5 min later . The change of a saturation of blood oxygen (SPO2)、respiration rate (RR)、mean arterial pressure（MAP）、heart rate（HR）before drug administration（T1）、and 5 min （T2）、15min （T3）、30min（T4）after drug administration were recorded . Anxiety visual analog test(AVAT)、serum glucose 、hydrocortisone were lower than those in the other groups . There were not significant difference between Apgar score of 1 and 5 min 、neurological and adaptive capacity score(NACS) 1 day after operation in the 4 groups of newborn. Conclusions Intravenous injection of small dose Midazolam before epidural anesthesia has a good antianxiety and anti-stress reaction effects on puerperants as preanesthetic medication in uterine-incision delivery operation , there is no side e