非全麻病人应用咪唑安定的顺行性遗忘作用

目的观察咪唑安定用于非全麻病人的顺行性遗忘作用。方法选择ASAⅠ～Ⅱ级,在腰-硬联合麻醉下行下腹部或下肢手术的病人120例,随机均分为咪唑安定组(A组)和氟哌利多组(B组),分别静注咪唑安定和氟哌利多后再行麻醉操作,观察两组病人对麻醉手术记忆的遗忘效果。结果A组完全遗忘40例(66.7%);不全遗忘20例(33.3%);B组不全遗忘10例(16.7%);无遗忘50例(83.3%)。两组遗忘程度比较差异有极显著意义(P<0.01)。结论非全麻病人应用咪唑安定有良好的顺行性遗忘效果。     

咪唑安定靶控输注时清醒镇静的临床观察

目的 探讨在腰一硬联合麻醉下用脑电双频指数(BIS)监测靶控输注(TCI)咪唑安定清醒镇静时,咪唑安定适宜的目标血药浓度.方法 选择60例腰一硬麻醉下行妇科手术患者,年龄45～65岁,ASA Ⅰ或Ⅱ级,随机均分为A、B、C三组.A、B、C组咪唑安定血浆靶控浓度分别为30、40、50 ng/ml.记录患者TCI眯唑安定30 min时BIS,同时记录咪唑安定不同血浆靶控浓度下警觉/镇静评分(0AA/S).维持术中BP、HR、SpO2至满意水平,记录术中、术后的感受情况、遗忘程度、麻醉的满意度.结果 A组患者术中BIS为89.5,OAA/S 4～5分.B组患者术中BIS为76.5,OAA/S 3分.C组患者术中BIS为68,OAA/S 1～2分.结论 腰一硬联合麻醉下手术患者咪唑安定以40ng/ml血浆靶控输注BIS在73～80.0AA/S 3分,术中镇静及顺行性遗忘效果好,安全性高,不良反应小,但应注意阻滞效果不完善时患者易引起极度躁动.     

异丙酚靶控输注镇静时记忆与BIS、AEPI和效应室药物浓度的关系

目的 研究异丙酚靶控输注(TCI)不同镇静深度对记忆的影响,探讨内隐记忆与脑电双频指数(BIS)、听觉诱发电位指数(AEPI)和异丙酚效应室药物浓度之间的关系。方法36例行择期下肢手术的患者,在硬膜外麻醉后TCI异丙酚镇静,根据镇静水平的不同随机分为3组,A组OAA/S评分3分,B组OAA/S评分2分,C组OAA/S评分1分。各组在镇静前呈现一次听刺激,达目标镇静深度后呈现第二次听刺激。监测第二次听刺激呈现前后的BIS和AEPI值。试验完毕后4 h采用加工分离程序对患者进行包含和排除测验,并推算内隐记忆和外显记忆成绩。结果 A组外显记忆和内隐记忆成绩与0相比差异有显著性(P<0.05);B组镇静期外显记忆成绩与0相比差异无显著性(P>0.05),内隐记忆成绩与0相比差异有显著性(P<0.05);C组外显记忆和内隐记忆成绩与0相比差异均无显著性(P>0.05)。A、B两组镇静期内隐记忆成绩差异无显著性(P>0.05)。内隐记忆成绩与BIS和AEPI有明显的相关性(P<0.01)。BIS、AEPI和效应室药物浓度均可很好地预测内隐记忆消失与否(P<0.01)。ROC曲线下面积:BIS>AEPI>效应室药物浓度。应用BIS、AEPI和效应室药物浓度诊断内隐记忆消失与否的截断点分别是:47、28、2.3 μg/ml。结论 在无伤害性刺激传入、无意识的情况下仍存在内隐记忆。镇静至OAA/S评分1分时     

咪唑安定在辅助区域麻醉中镇静深度及用量观察

目的分析咪唑安定用于辅助区域麻醉的适宜镇静深度及用量。方法随机将180例区域麻醉患者分成A、B、C 3组,各60例。分别在麻醉后应用咪唑安定使OAA/S镇静深度达到Ⅳ、Ⅲ、Ⅱ级,观察用药前后患者生命体征的变化、烦躁发生率、遗忘率,以及药物平均用量。结果随着咪唑安定的镇静深度加强,完全遗忘率逐渐增加,差异有统计学意义(P<0.05)。3组患者加深镇静深度时,血压均有一定程度的下降,差异无统计学意义。C组在用药5min后SpO2有明显下降,与A、B组比较差异有统计学意义(P<0.05)。烦躁发生率C组高于A、B组,差异有统计学意义(P<0.05)。镇静深度达到Ⅳ、Ⅲ、Ⅱ级时A、B、C组的咪唑安定用量分别为(0.035±0.018)、(0.055±0.032)、(0.108±0.052)mg/kg。结论区域麻醉时辅助应用咪唑安定达到的适宜镇静深度应为OAA/SⅢ级,用量建议为(0.055±0.032)mg/kg。     

咪唑安定联合芬太尼在结肠镜检查中的应用研究

目的观察咪唑安定联合芬太尼在结肠镜检查中的镇静、镇痛效果。方法将需行结肠镜检查的145例ASAⅠ～Ⅱ级患者随机分为A组（70例）和B组（75例）。A组采用传统结肠镜方法检查并施行常规护理；B组采用无痛检查方法，即静脉推注咪唑安定0．05mg／kg、芬太尼1μg／kg，1～2min后开始进行结肠镜检查；检查前、中、后均施予针对性护理支持。结果两组MAP、HR组间变化差异有显著性意义（均P〈0．01）；B组呼吸抑制发生率为4．00％；B组92．00％患者镇静程度达Ramsay 2～3级水平，效果显著优于A组（P〈0．01）；B组镇静镇痛效果、遗忘及满意程度和再次接受结肠镜意愿显著优于A组（均P〈0．01）。结论咪唑安定联合芬太尼用于结肠镜检查具有良好的镇静、镇痛效果，且安全；护理支持是顺利完成检查的有效保障。     

小剂量氯胺酮复合咪唑安定辅助腰硬联合麻醉的临床观察

目的观察小剂量氯胺酮复合咪唑安定辅助腰硬联合麻醉的效果。方法选择40例经腹子宫全切病人,随机分为氯胺酮复合咪唑安定组(A组)和芬太尼复合氟哌啶醇组(B组),在腰硬联合麻醉成功后,A组静脉给氯胺酮0.4mg/kg+咪唑安定0.05mg/kg,B组静脉给芬太尼1.0μg/kg+氟哌啶醇0.05mg/kg,观察并记录术中各时段SBP、DBP、SpO2、HR,记录术中镇静和遗忘情况,及抗牵拉反应效果。结果给药后A组各时段SBP、DBP、HR差异无统计学意义,B组给药后5min、15minSBP、DBP、HR值与术前相比下降明显(P<0.05),A组镇静及遗忘程度比B组好,两组都取得良好的抗牵拉效果,两组都无精神症状。结论小剂量氯胺酮复合咪唑安定辅助腰硬联合麻醉时,有良好的镇静和镇痛及遗忘作用,且无精神症状,应用效果良好。     

咪唑安定辅助区域麻醉合适镇静深度及用量的探讨

目的　探讨咪唑安定辅助区域麻醉的合适镇静深度及用量。方法　150例区域麻醉病 人随机分为A、B、C三组,分别在区域麻醉后,使用咪唑安定至OAA/S镇静深度Ⅱ、Ⅲ、Ⅳ级,观察用 药前后病人血压、心率和脉搏血氧饱和度(SpO2)的变化,对病人术中烦躁的发生率及术中事件的遗 忘率进行评估,并统计各组病人咪唑安定的平均用量。结果　使用咪唑安定后镇静深度与遗忘效果 有一致的变化。A组病人近事遗忘率为84%,B组98%,C组100%。与用药前相比,三组病人的血 压在用药后5、10min有一定程度的下降,下降幅度超过20%的病人A组4例、B组5例、C组5例 C组SpO2在用药后3、5min有明显下降,共有8例降至93%以下,与A、B两组相比,有显著性差异 (P<0.05,P<0.01)。C组烦躁发生率为22%,与A、B两组相比,有显著性差异(P<0.05,P< 0.01)。A、B、C三组达到相应镇静深度咪唑安定用量分别为(0.04±0.02)、(0.06±0.03)、(0.11± 0.05)mg/kg。结论　咪唑安定辅助区域麻醉的合适镇静深度为OAA/SⅢ级,用量为(0.06±0.03) mg/kg。     

异丙酚病人自控镇静与靶控镇静的对比研究

目的 比较异丙酚病人自控镇静术（PCS）与靶控镇静术（TCI）在硬膜外麻醉中的应用价值。方法 32例行下肢或下腹部手术的成年患者,硬膜外麻醉满意后,随机分成两组,PCS组行病人自控镇静,单次剂量0.3mg/kg,锁定时间2min;TCI组行靶控输注,术中维持镇静深度于OAA/S镇静评分3分。监测不同时点的镇静评分、双频谱指数（BIS）、边缘频率（95％SEF）、异丙酚靶浓度（CP）及血药浓度（Cm）、术中遗忘及镇静满意程度,并比较BIS、95％SEF及Cm与镇静评分的相关性。结果 所有患者均对镇静效果满意,PCS组镇静深度较浅,异丙酚用药量较TCI组少（分别为 2.5mg·kg-1·h-1与 3.8mg·kg-1·h-1,P<0.01）,且个体差异明显。TCI组血药浓度平稳,并与靶浓度基本相符,术中及术后遗忘率较自控镇静组高（分别为31％与69％,P<0.01）。BIS与镇静评分的相关性（γ=0.73）较95％SEF及Cm高。结论 两种方法镇静效果均满意,但又各具特点。自控镇静体现了个体化给药原则,用药量较少,其合理的设置至关重要。靶控镇静的深度平稳且易于调控,遗忘良好,但由于其治疗窗较窄,需要有良好的监测。BIS是监测硬膜外麻醉中镇静深度的较敏感指标。     

椎管内麻醉前肌注咪唑安定的遗忘作用与脑电变化

目的：评价咪唑安定所产生的遗忘作用和相应的脑电变化，方法：４０例椎管内麻醉中层得随机双盲分为四组，咪唑安定０．１５ｍｇ／ｋｇ和０．１０ｍｇ／ｋｇ安定０．２０ｍｇ／ｋｇ，生理盐水２ｍｌ，麻醉前３０分有注，观察用药前后脑电改变，镇静分级，对麻醉操作的遗忘率和程度以及术后心理状况，结果：用咪唑安定后镇静程度与遗忘效果有显著一致的变化，０．１０ｍｇ／ｋｇ咪唑安定的遗忘率为７０％，其中９０％为不全遗忘；０．     

氯硝安定作为麻醉前用药效果的临床观察

６０例手术病人随机分为氯硝安定组，安定线和苯巴比妥组，对比观察不同术间用药的镇静，催眠和抗焦虑等作用，结果：氯硝安定的镇静催眠作用比其他二组强而持久（Ｐ〈０．０１）抗焦虑作用和遗忘试验与其他二组比较，有高度显著性差异（Ｐ〈０．０５）。氯硝安定能延缓术后疼痛反应，并产生完全或部分顺行性遗忘，作为麻醉前用药，氯硝安定比安定苯巴比妥具有较好的临床效应。     

EFFECT OF FLUMAZENIL ON MIDAZOLAM-INDUCED AMNESIA

We have studied the effect of i.v. flumazenil 0.01 mg kg^–1on the amnesia and sedation caused by midazolam 2 mg and 5 mgi.v. in volunteers in order to determine the relationship betweenthe actions of the antagonist on these two effects. Midazolamcaused dose-dependent central neural depression as assessedby critical flicker fusion frequency, and dose-dependent amnesiafor word cards. In subjects given flumazenil 5 min after administrationof midazolam, fusion frequency readings and memory were restoredto levels comparable to those before midazolam administration.These two effects of flumazenil were similar in time courseand extent, suggesting that they share the same mechanism ofaction. Flumazenil given alone had no effect on memory. Thestudy has demonstrated anterograde amnesia following benzodiazepineadministration and antagonism by flumazenil. There was neitherretrograde amnesia nor retrograde antagonism of amnesia.     

Midazolam: effects on amnesia and anxiety in children

BACKGROUND: The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administration may not be tolerated. METHODS: Children (n = 113) undergoing general anesthesia and surgery completed preoperative baseline memory testing using a validated series of picture cards and were randomly assigned to one of three midazolam groups or a control group. Exactly, 5, 10, or 20 min after receiving oral midazolam (0.5 mg/kg) or 15 min after receiving placebo, children were administered a second memory test that used pictures. Anxiety of children was assessed during induction of anesthesia with use of a validated anxiety measurement tool. Postoperatively, recall and recognition for picture cards seen during baseline testing and postintervention testing were assessed. RESULTS: Postoperatively, recall and recognition of pictures presented to patients after drug administration (anterograde amnesia) showed significant group differences (P = 0.0001), with recall impaired in the 10- (P = 0.004) and 20-min groups (P = 0.0001). Similarly, recognition memory was impaired in the 5- (P = 0.0008), 10- (P = 0.0001) and 20-min (P = 0.0001) groups. Significant anxiolytic effects of midazolam were observed as early as 15 +/- 4 min after midazolam administration (P = 0.02). CONCLUSIONS: Midazolam administered orally produces significant anterograde amnesia when given as early as 10 min before a surgical procedure.     

Midazolam: Effects on Amnesia and Anxiety in Children

Background: The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administration may not be tolerated.

Methods: Children (n = 113) undergoing general anesthesia and surgery completed preoperative baseline memory testing using a validated series of picture cards and were randomly assigned to one of three midazolam groups or a control group. Exactly, 5, 10, or 20 min after receiving oral midazolam (0.5 mg/kg) or 15 min after receiving placebo, children were administered a second memory test that used pictures. Anxiety of children was assessed during induction of anesthesia with use of a validated anxiety measurement tool. Postoperatively, recall and recognition for picture cards seen during baseline testing and postintervention testing were assessed.

Results: Postoperatively, recall and recognition of pictures presented to patients after drug administration (anterograde amnesia) showed significant group differences (P = 0.0001), with recall impaired in the 10- (P = 0.004) and 20-min groups (P = 0.0001). Similarly, recognition memory was impaired in the 5- (P = 0.0008), 10- (P = 0.0001) and 20-min (P = 0.0001) groups. Significant anxiolytic effects of midazolam were observed as early as 15 +/- 4 min after midazolam administration (P = 0.02).     

COMPARISON OF MIDAZOLAM BY MOUTH AND DIAZEPAM I.V. IN OUTPATIENT ORAL SURGERY

In a randomized double-blind, parallel groups study, 40 patientsundergoing surgical removal of impacted 3rd molar teeth receivedeither midazolam 15 mg orally followed at 35 min by i.v. saline,or oral placebo followed at 35 min by i.v. diazepam 10 mg (Diazemuls).Rapid onset of sedation was seen after midazolam, while thepattern and duration of postoperative sedation, as measuredby standard psychometric tests, indicated slower recovery aftermidazolam than after diazepam. Ratings by the surgeon indicatedsuperior anxiolysis following midazolam and significantly morepatients expressed a preference for oral midazolam sedation.Significant, comparable anterograde amnesia was seen with bothtreatments. No significant cardiovascular complications occurredwith either treatment. The findings indicate that rapidly actingoral benzodiazepines such as midazolam provide safe, effectalternatives to i.v. diazepam for conscious sedation in outpatientsundergoing minor surgical procedures.     

比较右美托咪定和咪唑安定对焦虑患者记忆功能的影响

【摘要】〓目的〓比较右美托咪定和咪唑安定对焦虑患者记忆功能的影响。 方法〓60例择期在腰硬联合麻醉下行下腹部或下肢手术且焦虑评分>30 mm的患者,随机等分为4组(n=15):右美托咪定(dexmedetomidine, DXM)0.5 µg·Kg^-1组(D0.5组)、右美托咪定1 µg·Kg-1组(D1组)、咪唑安定组(M组)和对照组(C组)。各组分别在L2/3间隙穿刺麻醉,麻醉平面固定后,分别于10 min内泵注DXM 0.5 µg·Kg^-1、DXM 1 µg·Kg^-1、咪唑安定0.07 mg·Kg^-1和生理盐水10 mL。评估各组患者术前及用药前、用药后30 min的焦虑、镇静程度及记忆情况以及手术结束后4小时的记忆情况。记录并比较4组患者术中的平均压(MBP)、心率(HR)、血氧饱和度(SpO₂)、呼吸次数(RR)等。 结果〓D_0.5、D₁及M组用药后均有一定程度的镇静作用,焦虑程度均较术前明显减轻(P<0.05)。与对照组相比,D_0.5、D₁、M组均有顺行性遗忘作用(P<0.05),D1组顺行性遗忘程度明显高于D_0.5组(P<0.05),与M组相当(P>0.05)。用药后D_0.5、D₁组MBP和HR低于M、C组(P<0.05)。各组RR无明显差异(P>0.05),而M组有2人SpO2下降至94%以下。 结论〓右美托咪定对焦虑患者有明显的镇静、抗焦虑作用,对记忆的影响与剂量有关。1 µg·Kg^-1右美托咪定的顺行性遗忘作用与咪唑安定0.07 mg·Kg-1相当。     

静脉麻醉药物、单胺化合物和逆行性遗忘的关系研究进展

学习和记忆是大脑的重要功能。遗忘即不能记忆,可分为顺行性遗忘和逆行性遗忘静。人类对逆行性遗忘的研究已有100年以上的历史。静脉麻醉药物如咪唑安定和异丙酚可以产生逆行性遗忘,也可以导致单胺化合物多巴胺和5-羟色胺的改变,而单胺化合物的变化被证明与逆行性遗忘有关,这可能是某些静脉麻醉药物产生逆行性遗忘的机制。现就静脉麻醉药物、单胺化合物和逆行性遗忘三者之间关系的研究状况作一综述。     

Sedation with intranasal midazolam for endoscopy of the upper digestive tract]

Twenty-nine patients, ranked ASA 1 or 2, scheduled for diagnostic gastroduodenal fibroscopy were randomly allocated into three treatment groups: intranasal midazolam (IN) 0.15 mg.kg-1; intramuscular midazolam (IM) 0.15 mg.kg-1, and placebo (P). Sedation and the fibroscopy were all carried out by the same anaesthetist and fibroscopist. Efficiency and tolerance of the method were assessed by monitoring the heart rate, systolic and diastolic arterial blood pressure, arterial oxygen saturation (pulse oximetry), the degrees of sedation, anxiety, and anterograde as well as retrograde amnesia. The patient's and endoscopist's reactions were also considered. Patients in group P were older than those of the other two groups (p less than 0.01). Sedation was more important and patients less anxious in groups IN and IM than in group P. Three patients in group IM had retrograde amnesia. There were no significant differences between the degrees of anterograde amnesia in the three groups. At no time during the study were there any significant differences in SpO2 between and within groups. Four out of the 9 patients in group P had a bad opinion of their experience, as compared with two out of the 20 in the midazolam groups; the difference was not statistically significant. Three hours after the procedure, all patients were fully awake. Intranasal administration of midazolam therefore seemed to be an interesting alternative for gastroduodenal fibroscopy, because it was simple, non traumatic, well tolerated, and did not result in arterial desaturation.     

A comparison of diazepam and midazolam as sedatives for minor oral surgery

Diazepam in propylene glycol (Valium, Roche) and midazolam (Hypnovel, Roche) were compared as sedatives in 40 patients undergoing minor oral surgery. Twenty patients received each drug. The cardiovascular effects, the acceptability of the drugs to patients and dentists and the incidence of anterograde amnesia and adverse venous sequelae were investigated. Serum benzodiazepine levels were measured and recovery studied by six psychomotor tests repeated over five hours. Both drugs provided safe and acceptable sedation. More amnesia was reported in the midazolam group and more adverse venous sequelae by the diazepam patients. The recovery tests showed that the time taken to return to pre-sedation scores varied with the tests used and there was no significant evidence of the midazolam group recovering more quickly. In particular, significant impairment of delayed memory recall persisted in both groups throughout the investigation period.     

Intravenous sedation in dental surgery

A study on intravenous sedation in dental surgery was conducted comparing diazepam and fentanyl with midazolam and fentanyl. The total number of patients was one hundred and eighty patients. One hundred and twenty patients received diazepam and fentanyl, and later when midazolam was available sixty patients received this drug with fentanyl. The cardiovascular effects, the anterograde amnesia and adverse venous sequelae were investigated. Both drugs gave safe and acceptable sedation. The diazepam group had more venous sequelae. The midazolam group had better amnesia effects with no incidence of venous sequelae.     

Amnesic effect of oral midazolam as premedication in children]

We evaluated the sedative and amnesic effects of oral midazolam as premedication in children. Sixteen children, aged 4-12 yr, undergoing elective minor surgery were divided into 2 groups. One group received midazolam 0.5 mg.kg-1 with atropine 0.03 mg.kg-1 orally. The other control group received only atropine 0.03 mg.kg-1. There was no significant difference in the sedative scale at induction between the 2 groups. Doll-recall was used to assess the amnesic effects. In the midazolam group, 75% of the children forgot dolls they had seen on entering the operating room. Midazolam produced significant anterograde amnesia but no retrograde amnesia. This result suggests that children who received midazolam as premedication forget unpleasant memories at induction and their postoperative emotional responses are least influenced by their memories. We conclude that oral midazolam 0.5 mg.kg-1 is an effective preanesthetic medication in children.