静脉输注氟比洛芬酯与芬太尼对咪唑安定镇静效果的研究

【目的】评价静脉输注氟比洛芬酯（凯纷）或芬太尼对咪唑安定镇静效果的影响及安全性。【方法】134例行下腹部或下肢择期手术病人,ASAⅠ～Ⅱ级,随机将病例分为凯纷复合咪唑安定组（凯纷组）和芬太尼复合咪唑安定组（芬太尼组）,每组67例。观察两组血压（MAP）、心率（HR）、呼吸频率（RR）、SpO2,采用警觉／镇静观察评分法（OAA／S）比较两组病人的镇静程度,围术期呼吸抑制情况（SpO2≤90％超过5s）、术中牵拉或止血带压迫不适及术后有无恶心、呕吐。术后随访,采用视觉模拟量表（VAS）进行疼痛评分,记录相应的VAS值。【结果】两组比较,芬太尼组围术期呼吸抑制的发生高于凯纷组（P〈0．05）但术后恶心呕吐发生差异不具有显著性（P〉0．05）,两组患者术后6h、12h VAS评分凯纷组明显低于芬太尼组,差异具有显著性（P〈0．05）,两组患者术中OAA／S评分,各时点的MAP、HR、RR、SpO2比较,差异不具有显著性（P〉0．05）。【结论】凯纷复合咪唑安定术前静脉输注与芬太尼复合咪唑安定比较,在辅助腰硬联合麻醉是安全的,其超前镇痛效果确切,副作用小,不影响咪唑安定的镇静效果,未增加呼吸抑制的风险。

Comparison Between the Effect of Flurbiprofen Axetil and Fentanyl Intravenous Infusion on Sedation of Midazolam

[Objective]To assess the effect of flurbiprofen axetil or fentanyl intravenous infusion on midazolam sedation and their safety during combined spinal-epidural anesthesia（CSEA）. [Methods] A total of 134 ASA Ⅰ-Ⅱ patients undergoing elective surgery of by thus or lower limb were randomly divided into flurbiprofen axetil group （ n =67） and fentanly group（ n ：67）. Mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR） and SpO2 were observed. OAA/S score method was used for assessing the degree of sedation. Respiratory depression （the time of SpO2 〈90% more than 5min）, diseomfortableness caused by drag or tourniquet during operation, postoperative nausea and vomiting were recorded. Postoperative pain was graded with the visual analog scale （VAS）, and the scores of VAS were recorded. [Results] The incidence of re spiratory depression during operation in fentanly group was higher than in flurbiprofen axetil group （ P 〈 0.05）. The incidence of nausea and vomiting in the two groups had no significant difference （ P 〉0.05）. The score of VAS in flurbiprofen axetil group was significantly lower than that in fentanly group at 6 and 12 hour after operation （ P 〈0.05）. Scores of OAA/s, MAP, HR, RR and SpO2 in the two groups had no significant difference （ P 〉0.05）. [Conclusion] Flurbiprofen axetil with midazolam is safe during CSEA, and has preemptive analgesia effect, and does not affect the sedation efficacy of midazolam, and also does not increase the risk of respiratory depression.