异丙酚与咪达唑仑用于消除连续硬膜外麻醉患者术中知晓的比较研究

目的观察异丙酚和咪达唑仑靶控输注（TCI）用于消除连续硬膜外麻醉患者术中知晓的效果,为临床工作提供指导。方法下腹部手术患者40例,ASAⅠ-Ⅱ级,随机分成硬膜外麻醉复合TCI异丙酚组（P组）和硬膜外麻醉复合TCI咪达唑仑组（M组）,每组20例。硬膜外麻醉效果满意后开始TCI,利用脑电双频指数（BIS）监测麻醉深度,术中保持BIS于55-45水平作为消除患者术中知晓的客观指标。并在BIS≤55后2 min（T1）、10 min（T2）3、0 min（T3）、60 min（T4）、手术结束前10 min（T5）5个时间点分别记录SBP、DBP、HR、SpO2。并观察记录患者的入睡时间（Ts）和苏醒时间（Ta）。结果2组患者的BIS都能达到55以下,各个时间点的HR、SpO2组间差异无统计学意义（均P〉0.05）,P组的Ts、Ta、SBP、DBP皆显著低于M组（P〈0.05或P〈0.01）,但2组的SBP、DBP、HR、SpO2均在安全范围。结论异丙酚和咪达唑仑TCI皆可安全有效地用于消除硬膜外麻醉患者的术中知晓。

Comparison of Target controlled Infusion with Propofol and Midazolam for Eliminating Awareness in Patients Undergoing Epidural Anesthesia

Objective To study the application of target controlled infusion （TCI） with propofol and midazolam for eliminating awareness in patients undergoing continuous epidural anesthesia （CEA）. Methods Forty patients undergoing lower-abdominal operation under continuous epidural anesthesia were randomly divided into two equal groups. Group P used TCI with propofol and Group M with midazolam. TCI was executed after satisfactory CEA. BIS was used to monitor the depth of aesthesia,which was kept at 55-45 through TCI duration to escape intraoperative awareness. SBP,DBP,HR,and SpO2 were recorded respectively 2 min （T1）,10 min （T2）,30 min （T3）,60 min （T4） after BIS below 55,and 10 min before the end of operation （T5）. Sleep time （Ts） and awake time （Ta） were also observed in the study. Results BIS could be controlled below 55 satisfactorily in two group patients. No significant difference was found in HR and SpO2 between two groups （all P〉0.05）. Ts,Ta.SBP and DBP in Group P was significantly less than Group M （P〈0.05 or P〈0.01）. SBP,DBP,HR and SpO2 in two groups were all in the safe area. Conclusion TCI with propofol and midazolam for eliminating awareness in patients undergoing epidural anesthesia are safe and effective.