咪唑安定-瑞芬太尼辅助硬膜外阻滞行下腹部手术的效果

目的研究咪唑安定-瑞芬太尼在硬膜外阻滞下行下腹部手术中的辅助效果及其不良反应。方法80例手术患者,ASAⅠ-Ⅱ级,随机分为4组,每组20例:哌异合剂组(PP)、氟瑞芬合剂组(DRF)、咪哌合剂组(MP)和咪瑞芬合剂组(MRF)。硬膜外阻滞首次剂量10min后静脉给药。记录给药后10min内的血压、心率和SPO2,镇静程度,术中的不良反应,术后随访对手术的记忆及对麻醉效果的评价。结果用药后10min,DRF组出现收缩压明显降低,与给药前比较有显著性差异,其它各组血压与用药前比较无明显改变;DRF、MRF和:MP组患者心率明显下降,PP组用药后心率出现一过性升高,10min恢复至用药前水平;各组SPO2下降小于5％,组内及组间比较均无显著性差异。镇静程度,对手术牵拉反应的抑制,术后顺行性遗忘和麻醉效果的评价,MP组和MRF组明显优于PP组和DRF组。结论咪唑安定复合瑞芬太尼,作为硬膜外阻滞行中下腹部手术的辅助用药,效果明显而且不良反应轻,能够减少对手术的不良记忆和提高麻醉满意率。

Supplementary effects of midazolam-remifentanyl to epidural blockage for patients undergoing lower-abdominal surgery

Objective To investigate the supplementary effect of midazolam-remifentanyl intravenously in patients undergoing lower-middle abdominal surgery under epidural blockade.Methods 80 ASAⅠ-ⅡGrade patients,scheduled for elective abdominal surgery were randomized into four groups:Group PP, Promethazine 50mg + ephedrine 100mg;Group DRF,droperidol 5mg +remifentanyl 0.1mg;Group MP,mida-zolam 5mg + pethidine 100mg and Group MRF, midazolam 5mg + remifentanyl 0.1mg;All the drugs were intravenously injected later 10 min after the first dose of epidural block. The blood pressure, heart rate and SpO2 were monitored, the degree of sedation and the adverse reaction were recorded during the operation. The patients were visited to evaluate the effect of amnesia and satisfaction of anesthesia post-operation.Results The SBP of Group DRF was lower than other groups after ten min. There were no differences in the changes of SPO2 in all four groups.The heart rate were obvious differences in the changes of DRF,MRF and MP groups.Obvious difference was found in the incidence of responses to surgical exploration.There was a higher risk of falling tongue in groups MP and MRF than in other groups.Conclusion Midazolam combined with remifentanyl or ephedrine is the most effective combination to assist epidural anesthesia for lower-middle abdominal operations.