米达唑仑对先天性心脏病心脏直视术后患儿镇静效果和血液动力学的影响评估

目的：评价米达唑仑静脉注射对先天性心脏病心脏直视术后患儿的镇静效果及其对患儿血液动力学的影响。方法：先天性心脏病心脏直视术后患儿采用单次静脉注射米达唑仑0．1mg／kg的方法，记录用药前、后病儿的Ramsay评分和监测血液动力学参数（收缩压、舒张压、心率），评价其对心脏直视术后患儿的镇静效果和血液动力学影响。结果：25例不同类型的先天性心脏病患儿用药前后Ramsay评分有显著性差异（P〈0．001）。SBP及DBP于用药后10min明显下降（P〈0．001），其中5例达低血压标准，需加快输液提高血压；15min后血压开始回升，60min后恢复至用药前水平。心率变化不明显（P〉0．5）。结论：米达唑仑对先天性心脏病心脏直视手术术后患儿有良好的镇静效果，即使是小剂量米达唑仑亦可引起明显的低血压，对血液动力学不稳定患儿使用时应小心。

Hemodynamic and sedative effect of midazolam following open heart surgery in children with congenital heart disease

Objective:To evaluate the hemodynamic responses and sedative effect of midazolam bolus following open heart surgery in children with congenital heart disease.Methods:All patients transferred from the operation room were put on ventilator.Invasive blood pressure and heart rate were closely monitored with SIEMENS 7000 monitor.Midazolam 0.1mg/kg intravenous bolus was administered when the child showed signs of recovering from anesthesia.The sedative effect was evaluated with Ramsay Sedation Score.Results:25 patients were included in this study.Midazolam intravenous injection showed excellent sedative effects in all patients with Ramsay score between 3 to 5 grade(P<0.001).Significant decrease in systolic blood pressure and diastolic blood pressure(P<0.001)were found 10 minutes after midazolam intravenous bolus.Hypotension occurred in 5 patients,and rapid infusion was needed to maintain blood pressure.The blood pressure began to rise in 15 minutes and restored to pre-medication level in 60 minutes.There was no significant change in heart rate after midazolam administration(P>0.5).Conclusions:Midazolam showed excellent sedative effect following open heart surgery.Midazolam intravenuos bolus,even in low dose,may cause significant blood pressure decrease.It is suggested that midazolam intravenous bolus be used with caution,especially in haemodynamic unstable state.