小剂量咪唑安定复合氟哌合剂在硬膜外麻醉中的应用

目的:探讨不同剂量咪唑安定与芬太尼或氟哌合剂(氟哌利多与哌替啶)合用于硬膜外麻醉镇静时的效果。方法:ASAⅠ～Ⅱ级行下肢或下腹部手术患者100例,按辅助用药不同随机分为5组(n=20):Ⅰ组为咪唑安定与芬太尼组、Ⅱ～Ⅴ组为不同剂量咪唑安定与氟哌合剂组。观察并记录给药时,给药后5min、10min、30min、60min、90min时各时间点患者的HR、SBP、DBP、SpO2、用药后不良反应、术中遗忘效果及OAA/S评分。结果:仅Ⅰ组有20%发生呼吸抑制,其他各组生命体征平稳;Ⅰ～Ⅴ组上呼吸道梗阻2分以上发生率分别为25%、0%、5%、20%、5%。Ⅰ～Ⅴ组患者在观察期内完全遗忘率分别为60%、25%、60%、65%、35%;OAA/S镇静评分在4分以内的时间分别为:Ⅰ组(60.5±12.68)min、Ⅱ组(61.6±10.83)min、Ⅲ组(88.4±13.56)min、Ⅳ组(89.5±14.28)min、Ⅴ组(65.3±18.43)min。结论:咪唑安定0.03mg/kg+氟哌啶0.03mg/kg+哌替利多0.6mg/kg为90min内下肢或下腹部手术硬膜外麻醉较适宜的辅助镇静方案。

Low dose of midazolam combined with meperidine-droperidol mixture in epidural anesthesia

Objective ：To examine the sedative effects of different dose of midazolam in combination with fentanyl or meperidine-droperidol mixture in epidural anesthesia. Methods：One hundred patients（ASA, Ⅰ - Ⅱ ） undergone the surgery in lower limbs or abdomen were randomly allocated to 5 groups by the pre-medieation（n = 20）. Group 1 received midazolam and fentanyl and group Ⅱ - Ⅴ were given different dose of midazolam combined with meperidine-droperidol mixture. The patients were observed in HR,SBP,DBP and SpO2 at the time of medication and post-drug period at 5,10,30,60 and 90 min, respectively, and post-drug adverse reaction,amnesia during operation besides OAA/S grade. Results：Respiratory depression occurred in 20% of the patients in group I and the patients in the 4 other groups were kept in well-balanced vital sign during the surgery. The perioperative incidence of airway obstruction scored above 2 was 25% ,0% ,5% ,20% and 5% ,respectively,in the 5 groups. OAA/S sedation grade scored greater than 4 was （60.5 ± 12.68） min in group Ⅰ ,（61.6±10.83）min in group Ⅱ,（88.4±13.56）minin group Ⅲ, （89.5 ± 14.28） rain in group Ⅳ and（65.3 ±18.43） min in group Ⅴ, respectively. Conclusion ： The favorable program for sedation with epidural anesthesia must be the dose of midazolam 0.03 mg/kg ＋ droperidol 0.03 mg/kg ＋ meperidine 0.6 mg/kg for the surgery of lower extremities and abdomen which lasts less than 90 minutes.