异丙酚联合咪达唑仑消除连续硬膜外麻醉患者术中知晓40例分析

目的探讨麻醉安全状态下异丙酚联合咪达唑仑消除连续硬膜外麻醉患者术中知晓的可行性及两药的合适用量。方法选择下腹部开腹手术患者40例,行硬膜外麻醉联合靶控输注异丙酚和咪达唑仑,观察患者呼吸指标、循环指标、脑电双频指数(BIS)和警觉/镇静观察(OAA/S)评分,并对相关指标进行相关分析。结果①异丙酚血浆靶浓度为(1.9～2.5)μg/mL、咪达唑仑血浆靶浓度为(0.15～0.3)μg/mL,患者无知晓,且呼吸循环等生命体征平稳。BIS与OAA/S评分标准呈正相关,而且不同OAA/S评分之间的BIS值有统计学差异。②BIS、OAA/S值与异丙酚、咪达唑仑两药剂量呈负相关。③异丙酚血浆靶浓度低于(0.8～1.0)μg/mL、咪达唑仑血浆靶浓度低于(0.08～0.12)μg/mL,BIS75时患者会出现术中知晓。结论异丙酚联合咪达唑仑TCI能有效消除CEA患者术中知晓。

Combination of Propofol and Midazolam for Elimination of Intraoperative Awareness:An Analysis of 40 Cases of Continuous Epidural Anesthesia

Objective To investigate the feasibility of propofol and midazolam for elimination of intraoperative awareness of continuous epidural anesthesia（CEA） patient and optimal dosage of the two dr μ gs. Methods Respiration, circulation, bispectral index（BIS）and the Observer Assessment of Alertness/Sedation（OAMS） score were assessed in 40 patients scheduled for abdominal operation under target-controlled infusion（TCI） with propofol and midazolam. Results ①When the propofol target concentration was at 1.9 to 2.5μg/mL and midazolam target concentration at 0.15 to 0.3 μg/mL,the patients showed stable vital sign with no intraoperative awareness,and there was a positive correlation between BIS and OAA/S with significant differences between different OAA/S scores and their corresponding BIS. ②There was an inverse correlation between the values of BIS and OAMS and the dosage of propofol and midazolam. ③When the target concentrations of propofol and midazolam were at less than 0.8 to 1.0 μg/mL and 0.08 to 0.12 μg/mL, respectively and BIS was more than 75 ,the patients had intraoperative awareness. Conclusion Propofol and midazolam TCI can effectively eliminate intraoperative awareness of the continuous epidural anesthesia patients.