摘要
目的探讨咪达唑仑遗忘作用的合适给药时机和剂量。方法以240例ASAⅠ级病人对椎管内麻醉穿刺操作的遗忘程度为评价指标,分为椎管内麻醉穿刺操作前(A)组和后(B)组,每组120例;每大组又随机分为4小组,分别给予不同剂量的咪达唑仑,分为0.01mg/kg(M1组)、0.03mg/kg(M2组)、0.1mg/kg(M3组)和生理盐水(NS)组,每组30例。记录用药后的警觉-镇静(OAA/S)评分和手术后1h的遗忘评分(amnesiascore,AS)。结果OAA/S评分:A组和B组中,不同剂量M组与NS组之间,不同OAA/S评分所占人数比例有明显差异;B组中M2与A组中M2相比,OAA/S评分秩次有显著差异,B组中M3组与A组中M3组相比,秩次有显著差异;AS评分:A组中,各剂量M组均有不同程度的遗忘;M2、M3组与M1组间相比,遗忘程度增加,P<0.05;而M2、M3组之间P>0.05;B组中,M1、M2组与NS组遗忘程度相似(P>0.05),而M3组与其余三组相比,遗忘程度明显增加,但其与A组中M3组相比,遗忘程度明显不如后者。结论咪达唑仑的镇静作用同其剂量成正相关;咪达唑仑具有明确的顺行性遗忘作用,并同镇静程度相关,但有封顶效应(ceilingeffect);在较大剂量情况下,亦能产生逆行性遗忘作用,但是效力不及同等剂量下预先给药;这提示咪达唑仑应以适当剂量、在有创操作前给药,可以产生满意的遗忘作用,剂量过大并不能够产生更强的遗忘作用。
Objective To investigate the appropriate timing and dose administration of midazolam that can induce amnesia and it＇ s extent. Methods After ethics committee approval and consent,240 adult female patients undergoing total or sub - total hysterectomy were randomly allocated to 2 groups： before puncture procedure of intravertebral anesthesia （A） and after puncture procedure of intravertebral anesthesia （ B）, 120 patients in each group; Each group was randomly divided into 4 sub - groups ： midazolam O. O1 mg/kg （ ML ） , midazolam O. 03 mg/kg（ ME ） , midazolam O. 1 mg/kg（ M3 ） and normal saline （NS）. 30 patients in each sub -group. OAA/S after Midazolam administration and amnesia score after operation finished in I h were recorded respectively. Results Both group A and group B, there was a dose - dependent deteriortion in OAA/S, sub - group M2 in group B compare with sub - group ME in group A , sub - group M3 in group B compare with sub -group M3 in group A , there was a significant difference in OAA/S （P 〈0.05）respectively. In group A , there was a significant difference in amnesia score （P 〈 0. 05） , but not dose - dependent, there was a significant difference in amnesia score between sub - group M2 and sub-group Ml, sub- group M3 and sub -group Ml respectively, but there was no significant differences between sub -group ME and sub - group M3. In group B, there was no significant differences in amnesia score between sub - group Ml , sub - group ME and normal sa- line, there was a significant difference between sub - group M3 and other sub - group, Particularly, the sub - group M3 in in group B per- formances lighter amnesia than sub - group M3 in in group A （ P 〈 0. 05 ）. Conclusions The sedation of Midazolam showed its dose - dependent. Midazolam can demonstrate anterograde amnesia and correlate with the degree of sedation, but there was a ceiling effect . In larger dosage circumstances, midazolam can also produce retrograde amnesia, but the extent of amnesia induce
出处
《医学研究杂志》
2007年第7期12-15,共4页
Journal of Medical Research
基金
国家自然科学基金资助项目(39970715
30471657)
江苏省自然科学基金资助项目(BK2001143)
