咪达唑仑联合氟马西尼在悬雍垂腭咽成形术麻醉苏醒期的应用

目的观察咪达唑仑联合氟马西尼用于悬雍垂腭咽成形术麻醉苏醒期的安全性及有效性。方法将行悬雍垂腭咽成形术的患者40例采用随机数字表法随机分为咪达唑仑组和丙泊酚组，各20例。2组患者均采用镇静健忘慢诱导行鼻腔插管，麻醉维持：咪达唑仑组以咪达唑仑0．1～0．2mg／（kg·h）恒速泵入维持术中镇静；丙泊酚组以丙泊酚4～6mg／kg恒速泵入维持术中镇静；2组患者术中均以瑞芬太尼0．2～0．4μg（kg·min）恒速泵入维持镇痛，间断静脉注射罗库溴铵维持肌松。手术结束后咪达唑仑组静脉注射氟马西尼至患者清醒。记录2组患者的入室时、插管即刻、拔管即刻、出室时的血流动力学变化；记录自主呼吸恢复时间、呼唤睁眼时间、拔管时间、警觉与镇静评分（OAA／S评分）情况以及达5分时间；记录患者不良反应情况。结果2组患者各时间点平均动脉压（MAP）和HR比较差异无统计学意义（P〉0．05），与人室时比较，诱导后MAP和HR均有所下降（P〈0．05）；2组患者自主呼吸恢复时间比较差异无统计学意义（P〉0．05）。咪达唑仑组患者呼唤睁眼时间（2．9±0．5）min]、拔管时间（5．4±1．2）min]及OAA／S评分达5分时间（7．0±1．5）min]明显短于丙泊酚组（10．1±2．0）rain，（12．6±2．3）min，（13．6±3．1）min]（均P〈0．05）；2组患者在苏醒期躁动／呛咳发生率差异无统计学意义（P〉0．05），2组患者拔管后均未发生再镇静及呼吸道梗阻，术后2组患者恶心呕吐发生率差异无统计学意义（P〉0．05）。结论咪达唑仑联合氟马西尼用于悬雍垂腭咽成形术麻醉可缩短患者的清醒时间，提高苏醒期的质量，是一种安全、有效的麻醉方法。

Application of midazolam and flumazenil in uvulopalatopharyngoplasty in anesthesia recovery period

Objective To observe the safety and effectiveness of midazolam-flumazenil for uvula palate pharyngoplasty anesthesia in recovery period. Methods Forty cases scheduled for UPPP surgery were selected and randomly divided into midazolam group （ group M, n = 20 ） and propofol group （ group P, n = 20 ）. Two groups were treated with sedation induced and nasal intubation. Intraoperative sedation was maintained in group M with midazolam 0.1-0.2 mg/（ kg · h） constant speed pump; group P was given propofol 4- 6 mg/kg to maintain constant speed pump. Intraoperafive constant analgesic of two groups was maintained with remifentanil 0.2 - 0.4 μg/（ kg ·min ） pumped. Intermittent intravenous rocuronium was maintained muscle relaxation. After surgery the patients of group M were intravenous injected of flumazenil to awake. The hemodynamic changes when entering the operating room, intubation, extubafion and out of the operating room were recorded. The time of spontaneous breathing recovery, calling eye opening, extubation and OAA/S score as well as up to 5 points time were recorded; adverse reactions were recorded. Results The difference of two groups＇ mean artery pressure （MAP） and HR at each time point was not statistically different （P 〉 0.05 ）. Compared with the time entering the operating room, MAP and heart rate （HR） decreased after the induction （ P 〈 0.05 ） ; the difference of spontaneous breathing recovery time of two groups was not statistically different （ P 〉 0.05 ）. Calling eye opening time （ 2.9 ± 0.5 ） lnin ], extubation time （ 5.4 ± 1.2 ）min ] and the time to 5 points of OAA/S score （7.0 ± 1.5 ）min ] in group M was significantly shorter in group P （ 10.1 ± 2.0） min, （ 12.6 ± 2.3 ） min, （ 13.6 ± 3.1 ） min ] （ all P 〈 0.05 ）. The incidence of restlessness/cough of two groups in recovery period was no significant different （ P 〉 0.05 ）. Two groups did not occur sedation again and respiratory obstruction after extubation. The incidence of postoperative nausea and vomiting and intraoperative awareness was no significantly different （ P 〉 0.05 ）. Conclusion Midazolam-flumazenil for uvulopalatopharyngoplasty＇ anesthesia can shorten the recovery time and improve the quality of recovery.