椎管内麻醉前肌注咪唑安定对术中镇静以及术后遗忘的影响

目的：探讨椎管内麻醉前肌注咪唑安定对术中的镇静作用和对术后遗忘的影响。方法：选择ASA1～2级择期在腰硬联合阻滞下行下肢手术的患者180例，随机分为咪唑安定组和苯巴比妥钠组，咪唑安定组患者入室后（实施麻醉前10min）肌内注射咪唑安定0．1mg／kg，苯巴比妥钠组患者入室前30min肌内注射苯巴比妥钠0．1g。采用Ramsay镇静评分法评价两组入室前、入室后、麻醉时的平均动脉压（MAP）和心率（HR），术后24h评价患者对麻醉操作及手术操作的遗忘程度。结果：两组患者入室前、后MAP、HR无明显变化（P〉0．05），苯巴比妥钠组麻醉时MAP、HR较入室前及咪唑安定组明显升高（P〈0．05～0．01）；咪唑安定的镇静作用优于苯巴比妥钠（P〈0．05）；咪唑安定组对麻醉和手术操作的完全遗忘率为43．3％，不全遗忘率为56．7％，而苯巴比妥钠组的不全遗忘率为24．4％，无遗忘率为75．6％，两组差异有统计学意义（P〈0．01）。结论：麻醉前10min肌内注射咪唑安定0．1mg／kg，可使患者消除焦虑、恐惧心理，既安静又能配合麻醉和手术体位，对麻醉和手术操作有很好的镇静和记忆遗忘作用。

Effect of intramuscular injection of midazolam before intravertebral anesthesia on sedation during operation and amnesia after operation

Objective:To explore the effect of intramuscular injection of midazolam before intravertebral anesthesia on sedation during operation and amnesia after operation.Methods:Selected 180 ASA cases at 1～2 stage with lower extremity surgery under combined spinal and epidural anaesthesia,and randomly divided them into midazolam group and phenobarbital sodium group.Gave patients in midazolam group intramuscular injection of midazolam at 0.1 mg/kg 10 min earlier before operation,while gave patients in phenobarbital sodium group 0.1 g phenobarbital sodium 30 min earlier.With Ramsay sedation evaluation assessed mean arterial pressure(MAP)and heart rate(HR)during anesthesia,before and after operation,respectively.Evaluated amnesia degree of patients 24 h later after operation.Results:There was no significant change of MAP and HR before and after operation in both groups(P>0.05).During anesthesia,MAP and HR was significantly higher than the score before operation in phenobarbital sodium group(P<0.05~0.01),while the sedative effect of midazolam was stronger than phenobarbital sodium(P<0.05).The total amnesia rate was 43.3% and incomplete amnesia rate was 56.7% in midazolam group,while the incomplete amnesia rate was 24.4% and no-amnesia rate was 75.6% in phenobarbital sodium group,with significant statistic difference between groups(P<0.01).Conclusion:Intramuscular injection of midazolam at 0.1mg/kg can help patients to get away from anxiety and terror,make them fit anesthesia and operation posture,and have satisfactory sedative and amnesia effect.