右美托咪定、咪唑安定及异丙酚术中镇静比较

目的 比较右美托咪定、咪唑安定及异丙酚在区域麻醉中的镇静作用. 方法 腰-硬联合麻醉下行下肢手术患者75例,ASA Ⅰ～Ⅱ级,随机分为右美托咪定组(D组)、咪唑安定组(M组)与异丙酚组(P组),各25例.分别于麻醉成功后给予右美托咪定、咪唑安定及异丙酚行术中镇静,使镇静/警觉评分(The observer(s) assessment of alertness/sedation scale,OAA/S)达3分或2分.监测血压、心率、血氧饱和度及心电图等生命体征,术后24h询问患者有无术中知晓. 结果 三组镇静效果均满意,有良好的顺行性遗忘,三组的术中知晓率无统计学差异(P＞0.05);D组、M组无呼吸抑制,P组有轻度呼吸抑制,且较D组、M组易发生(P＜0.05);D组有2例血压升高、1例血压下降,M组血压无变化,P组有5例血压下降,P组较M组易引起血压下降(P＜0.05);D组心率下降明显,2例要用阿托品,M组、P组心率稳定,D组心率明显慢于M组与P组(P＜0.01). 结论 术中镇静,右美托咪定降低心率明显,异丙酚有轻度的呼吸、循环抑制,但都易于纠正;咪唑安定对呼吸、循环无影响.右美托咪定、咪唑安定及异丙酚都可用于区域麻醉的镇静.

Effect Comparison on Intraoperative Sedation of Dexmedetomidine,Midazolam and Propofol

Objective To compare the intraoperative sedation effect of dexmedetomidine,midazolam and propofol under regional anaesthesia.Methods Seventy-five patients with ASAⅠ~Ⅱ underwent operation on lower limbs under combined spinal-epidural anesthesia(CSEA) were randomly allocated into three groups: Dexmedetomidine group(as group D,n=25),midazolam group(as group M,n=25) and propofol group(as group P,n=25).Dexmedetomidine,midazolam and propofol were administered intravenously to group D,M and P respectively for sedation following CSEA.The Observer’s assessment of alertness/sedation scale(OAA/S) were evaluated and reached 3 or 2 points in three groups.Vital signs of BP,HR,ECG and SPO2 were monitored and intraoperative awareness was inquired 24 hours after operation among three groups.Results Sedation and amnesia were satisfied in three groups.There was no statistic difference in awareness rate among three groups(P>0.05).Respiration was stable in group D and M,and was slight inhibited in group P;and the respiratory inhibition was happened more easily in group P than in group D or group M(P<0.05).The level of BP was risen in 2 patients and declined in 1 patient in group D,was stable in group M and was reduced in 5 patients in group P.Compared with group M,BP of group P was easier to decline(P<0.05).HR was decreased obviously in group D,and two patients needed atropine.HR changed slightly in group M and P;so group D had lower HR among three groups(P<0.01).Conclusions Used for intraoperative sedation,dexmedetomidine decreased HR significantly and propofol inhibited respiratory and circulative function slightly,but which can be corrected easily.Midazolam had little effect on vital signs.So dexmedetomidine,midazolam or propofol can be safely used for sedation during regional anesthesia.