硬膜外穿刺中应用咪达唑仑的临床观察

为观察硬膜外穿刺前应用国产咪达唑仑注射液的最适剂量 ,选择 1 5 0例病人随机双盲分成 5组 ,每组 3 0人。第 1组为对照组 ,第 2、3、4、5组分别静脉注射咪达唑仑注射液 0 .0 2、0 .0 4、0 .0 6、0 .0 8mg/kg。观察平均动脉压、心率、呼吸、血氧饱和度、记忆及镇静程度的变化。第 1、2组硬膜外穿刺操作后平均动脉压增加 2 .3kPa、心率平均增加 1 1次 /min ,第 1、2组间无差异 ;且 2组用药前后平均动脉压与心率无差异 ;第 3组操作前后和用药前后平均动脉压、心率均无显著差异。用药后与用药前相比 ,第 4、5组平均动脉压下降 ,心率减慢 ,但均在正常范围 ;用药后组间平均动脉压与心率无差异。呼吸及血氧饱和度各组均在正常范围。第 1、2、3、4、5组记忆率分别为 1 0 0 %、87%、40 %、1 7%及 0 ,用药后均有顺行性遗忘作用 ,第 3、4组顺行性遗忘作用强。镇静程度 :第 1～ 4组均为清醒或入睡可唤醒 ,第 5组有 9例病人入睡唤醒困难但睫毛反射存在 ,用药后第 2、3、4组患者均可主动配合操作 ,第 5组有少数病人不能主动配合。提示 :硬膜外穿刺前静脉注射 0 .0 4～ 0 .0 6mg/kg咪达唑仑可稳定生命体征 ,消除对不良刺激的记忆 ,且患者可主动配合操作 ,因此 ,值得在硬膜外穿刺前应用

Clinical Observation of the Efficacy of Midazolam in the Epidural Puncture

To determine the optimal dosage of midazolam administered in the epidural puncture. Method: 150 patients were divided into 5 groups randomly, 30 patients each group. Group 1 were given saline 2 mLiv before epidural puncture. Group 2～5 had 0.02、0.04、0.06、0.08 mg/kg midazolam adiministered before epidural puncture respectively. The changes of MAP, HR, R, SpO₂, memory and sedative degree were observed. Results: The MAP, HRincreased dramatically by 2.3 kPa and 12 bpm in group 1 and group 2 and there were no differences in MAP and HR changes between the two groups. There were no differences in MAP and HR changes in group 3 post-puncture. After midazolam was administered MAP and HR decreased respectively by 1.1 kPa and 8 bpm in group 4 and 5. RR AND SpO₂ kept normal in all groups. The memory rates were 100%, 87%, 40%, 17% and 0 in group 1～5 respectively. Sedative degree: the patients kept conscious or could be awaked easily in group 1～4 and there were 9 patients in group 5 with difficulty to awake but the lid reflex existed. Midazolam of 0.04～ 0.06 mg/kg iv before epidural puncture provides ideal procedural state, stabilizes the Vital signs, eliminates the vicious memory and brings patients comfort.