摘要
【目的】评价腰硬联合麻醉复合咪唑安定、丙泊酚镇静在老年手术中的可行性及镇静效果。【方法】择期下腹部、会阴、下肢手术患者70例，65～79岁，ASAI～Ⅲ级，分为咪唑安定组（M组，n=20）和丙泊酚组（P组，n=20）和咪唑安定复合丙泊酚组（C组，n=30），三组病人均于L2～3或L3～4行腰硬联合麻醉，蛛网膜下腔注入重比重0．5％布比卡因8～12mg，三组病人手术开始前5min，M组静注咪唑安定0．06mg／kg，P组先注入丙泊酚1mg／kg，C组先静注咪唑安定0．04mg／kg，然后P、C两组泵入丙泊酚，维持0AA／S为2～3分。观察其对MAP、HR、SpO2影响，比较三组患者镇静分级与遗忘调查及对手术操作过程及术中所看到的图片的回忆。【结果】M组MAP下降20％有2例，P组有7例，C组有2例，P、C两组相比差异有显著性（P〈O．05）。三组Sp02下降至93％的比例无差异。M组镇静评分为3～4分，对手术操作及图片有部分回忆，镇静效果基本满意。P组镇静评分为2～3分，对手术操作无记忆，对图片部分有部分回忆，镇静遗忘效果基本满意。C组镇静评分为2～3分，对手术操作和图片均无记忆，镇静遗忘效果非常满意。C组丙泊酚用量明显少于P组（P〈O．05）。【结论】在老年下腹部、会阴、下肢手术中，应用腰硬联合麻醉复合咪唑安定、丙泊酚镇静麻醉满意，有明显抗焦虑、镇静和顺应性遗忘作用，但仍要警惕对呼吸循环的影响。
[Objective] To evaluate the sedative effect of midazolam combined with propofol during spinal anesthesia in elderly elective operation. [Methods] Seventy patients with ASA class I or III elected for the operation of lower abdominal, perineal, lower limbs were assigned into three groups. The patients in group M, P and C were given midazolam, propofol or midazolam combined with propofol respectively after delivery of spi- nal anesthesia. The spinal anesthesia was combined with epidural block in three groups and maintained with a dose of 0.5% bupivacaine when necessary. The OAA/S score was maintained 2 to 3 in three groups. Their effects on MAP, HR, SpO2, the frequency of dysphoria, and the recall of the surgery and pictures were observed. [Results]There was significant difference in the decrease of MAP between three groups. But the decrease of SpO2 among three groups was insignificant. The sedation and recall of surgery were significantly different （ P 〈0.01）. The total dosage of propofol in group C was lesser than that in group P. [Conclusion] Midazolam combined with propofol during spinal anesthesia in elderly patients can provide adequate analgesia and amnesia, but respiratory depression should be concerned.
出处
《医学临床研究》
CAS
2008年第2期225-227,共3页
Journal of Clinical Research
