咪达唑仑和芬太尼用于腰硬联合麻醉镇静的临床观察

目的：观察不同剂量咪达唑仑加芬太尼用于腰硬联合麻醉镇静的临床效果。方法：80例ASAⅠ～Ⅱ级下腹部手术患者随机分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4组，分别采用0．02、0．04、0．06和0．08mg／kg咪达唑仑辅助芬太尼0．001mg／kg进行腰硬联合麻醉镇静，以改良警觉／镇静评分法（OAA／S）记录给药不同时间患者的镇静程度、遗忘程度，观察术中患者生命体征的变化。结果：给药后5minⅠ组、Ⅱ组OAA／S评分明显高于Ⅲ组、Ⅳ组（P〈0．05），给药后10、30、60minⅠ组OAA／S评分明显高于Ⅱ、Ⅲ、Ⅳ组（P〈0．05～0．01）。给药后30minⅡ、Ⅲ、Ⅳ组遗忘作用均优于Ⅰ组，Ⅲ、Ⅳ组优于Ⅱ组（P〈0．05），给药后120minⅢ、Ⅳ组遗忘作用优于Ⅰ、Ⅱ组（P〈0．05）。镇静、遗忘程度依次为Ⅳ组〉Ⅲ组〉Ⅱ组〉Ⅰ组。4组各生命体征指标差异无统计学意义（P〉0．05），均未发生严重的血压下降，Ⅳ组呼吸抑制发生率最高。结论：0．04～0．06mg／kg咪达唑仑辅助0．001mg／kg芬太尼较适用于腰硬联合麻醉的镇静、遗忘剂量。

Effect of midazolam and fentanyl on combined spinal-epidural anesthesia and sedation

Objective:To determine the effects of different doses of midazolam and fentanyl on combined spinal-epidural anesthesia and sedation. Methods:Eighty patients undergoing grade ASAⅠ~Ⅱlower abdominal surgery were divided randomly into 4 groups:group I,II,III and IV; 0.02,0.04,0.06 and 0.08 mg / kg midazolam and 0.001 mg / kg fentanyl were used respectively for combined spinal-epidural anesthesia and sedation,and degrees of sedation,oblivion were recorded at different time of drug administration according to modified Observer's Assessment of Alertness / Sedation Scale (OAA / S) ,with observation of changes of vital signs. Results:OAA / S scores in groupⅠandⅡ5min after administration were significantly higher than that in group Ⅲ and Ⅳ(P<0.05),OAA / S score in groupⅠ10,30,60 min after administration was significantly higher than that in groupⅡ,Ⅲ,Ⅳ(P<0.05 ~ 0.01). 30 min after administration,the forgeting degrees in groupⅡ,Ⅲ,Ⅳ were all better than that in groupⅠ,and Ⅲ,Ⅳgroup were better than that in groupⅡ (P<0.05); 120 min after administration,the forgeting degrees in group Ⅲ,Ⅳ were better than that in groupⅠ,Ⅱ( P<0.05). The order of degrees of sedation and oblivion was group Ⅳ> group Ⅲ> groupⅡ> groupⅠ. Indicators of the vital signs between the 4 groups were no significant differences (P>0.05),no serious low blood pressure occurred,respiratory depression occurred more in group Ⅳ. Conclusion:0.04 ~ 0.06 mg / kg midazolam combined with 0.001 mg / kg fentanyl is the appropriate dosage for sedation and oblivion of combined spinal-epidural anesthesia.