靶控输注咪达唑仑对硬膜外麻醉寒战的影响

目的:观察靶控输注(target controlled infusion,TCI)咪达唑仑对硬膜外麻醉寒战的影响。方法:选择硬膜外麻醉下行下腹部手术发生寒战患者40例,随机分成2组,每组20例。寒战出现后2min内,A组TCI咪达唑仑,B组静脉注射芬氟合剂。监测2组患者术前和术中生命体征的变化,警觉/镇静(OAA/S)观察评分法监测镇静程度,评价治疗寒战的疗效。结果:2组患者术中平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO₂)总体处于平稳状态,均在正常范围内。2组患者MAP、HR的监测值在给药后各时间点差异均无统计学意义(P>0.05),而SpO₂监测值给药后10min差异有统计学意义(P<0.01)。A组治疗寒战有效率明显大于B组(P<0.01)。2组给药后各时间点镇静评分差异均有统计学意义(P<0.05~P<0.01)。其中A组OAA/S评分维持在2~3分,B组OAA/S评分在5min和10min时维持在3~4分,随着时间的延长,镇静程度减弱。结论:TCI咪达唑仑减轻硬膜外麻醉寒战安全、方便、有效。

Clinical observation of target-controlled infusion with midazolam for shivering in patients undergoing epidural anesthesia

Objective：To investigate the effect of target controlled infusion（TCI） with midazolam for shivering in patients undergoing epidural anesthesia.Methods：Forty patients undergoing lower-abdominal operation with shivering were randomly divided into two equal groups（n = 20,respectively） ：group A combined TCI with midazolam,while group B combined intravenous injection with droperidol-fentany.The changes of vital sign were monitored before and during operation.The sedation degree was evaluated by the Observer＇s Assessment of Alertness/Sedation（OAA/S） Scale.The therapeutic effect of shivering was estimated.Results：The numbers of mean arterial pressure（MAP）,heart rate（HR） and pulse oxygen saturation（SpO2） were stable during the operation between two groups.They were within normal limits.Although the numbers of MAP and HR in group B after administration were lower than preoperative,the patients need not be treated.There were no significant differences in MAP and HR at different periods after the administration between two groups（P〈0.05）.While there was significant difference in SpO2 at minite 10（P〈0.01）.The effective power of treating shiver of group A was better than group B（P〈0.01）.There was significant difference in sedation scale at different periods after the administration between two groups（P〈0.05 to P〈0.01）.The OAA/S scale in group A maintained 2 to 3.The scales were 3 to 4 in group B at minite 5 and 10.The sedation degree weakened along with time prolonged.Conclusions：TCI with midazolam for shivering in patients undergoing epidural anesthesia is safe and convenient and effective.