舒芬太尼、咪达唑仑辅助硬膜外腔阻滞麻醉用于胆囊切除术的临床观察

目的观察舒芬太尼、咪达唑仑辅助硬膜外腔阻滞麻醉用于胆囊切除手术时镇静和抑制内脏牵拉反应的效果，并观察其对循环及呼吸功能的影响。方法40例择期行胆囊切除手术患者在知情同意情况下，按数字表法随机分为A组和B组各20例，两组均常规进行硬膜外腔阻滞麻醉，平面形成后，于切皮前5min静脉注射辅助药物：A组：首剂静脉注射（1—2min内）舒芬太尼0．1μg/kg十咪达唑仑0，02mg／kg，随后微量泵持续输注舒芬太尼0．2μg·kg^-1·h^-1＋咪达唑仑0．04mg·kg^-1·h^-1，于手术关闭腹腔时停药。B组：哌替啶1mg／kg＋氟哌利多0．05mg／kg单次缓慢静脉滴注。观察并记录两组血压、心率、血氧饱和度变化情况及Ramsay镇静程度和内脏牵拉反应分级情况。结果两组患者麻醉后血压、心率、血氧饱和度等均有不同程度下降，但组间差异均无统计学意义（均P〉0．05）；Ramsay镇静分级：A组达Ⅱ、Ⅲ、Ⅳ级分别为3例、8例、9例，与B组的4例、13例、3例相比较，差异有统计学意义（u=3．75，P〈0．05）；A组内脏牵拉反应（0～Ⅲ级）分别为9例、9例、1例、1例，与B组的4例、5例、7例、4例比较，差异有统计学意义（u=4．01，P〈0．01）。结论舒芬太尼、咪达唑仑辅助硬膜外腔阻滞麻醉用于胆囊切除术中，可明显改善镇静程度，防治内脏牵拉反应，对呼吸循环干扰小。

Clinical observation of sufentanil and midazolam assisted epidural anesthesia for cholecystectomy

Objective To investigate the effect of sufentanil and midazolam assisted epidural anesthesia for cholecystectomy on sedative effects,visceral pulling reaction and the functions of respiratory and circulatory system.Methods Fourty patients underwent cholecystectomy received informed consent, were randomly allocated to two groups:group A and group B( n =20 each). When the level of epidural block is appropriate,auxiliary medicine infusion was given 5min before the skin incision. In group A,first injection was sufentanil 0. lμg · kg-1 and midazolam 0. 02mg · kg-1 in 1-2 min, then continuous infusion of sufentanil and midazolam was given at the rate of 0. 2μg ·kg-1 · h-1 and 0. 04μg · kg-1 · h-1 respectively,and the infusion was stopped at the time of wound closure. Group B received slow intravenous injection of pethidine 1mg · kg-1 and droperidol 0. 5mg · kg-1. We recorded the differences of SBP、DBP、SpO2 、HR、Ransay score and visceral pulling reaction classification. Results SBP、DBP、HR after anesthesis,were decreased in different degree in the above groups,but there was no statistically significant difference( P ＞0. 05). According to Ramsay score,in group A there were 3 cases in grade Ⅱ、8 cases in Ⅲ and 9 cases in Ⅳ ,while in group B there were respectively 4 cases in Ⅱ、13 cases in Ⅲ and 3 cases inⅣ. By comparision,the differences had statistical significance ( u = 3.75, P ＜ 0. 05 ); Group A according to visceral pulling reaction classification (0- Ⅲ ), were 9 cases in grade 0,9 cases in Ⅰ , 1 cases in Ⅱ and 1 cases in Ⅲ, while in group B there were respectively 4,5,7 and 4 cases. By comparision, the differences had statistical significance(u = 4. 01,P ＜ 0. 01 ). Conclusion In the cholecystectomy,sufentanil and midazolam assisted epidural anesthesia,could improve the level of sedation ,prevent visceral pulling reaction ,and had a minor interference to respiratory and circulatory function.