| | | 咪唑安定对布比卡因蛛网膜下腔麻醉效果的影响
| | 医学生暑期实践论文【摘要】 目的医学生暑期实践论文 观察咪唑安定加入布比卡因对蛛网膜下腔麻醉维持时间和麻醉效果的医学生暑期实践论文影响。方法 40例ASA Ⅰ级子宫切除病人随机分为咪唑安定组（试验组，n=20）和对照组（n=20）。咪唑安定组蛛网膜下腔注入0.5%重比重布比卡因2.5ml加咪唑安定1mg(0.2ml)，对照组注入0.5%重比重布比卡因2.5ml加生理盐水0.2ml。观察运动神经阻滞（改良Bromage）、感觉神经阻滞（针刺法）、镇痛时间（VAS）、术者和患者对麻醉的满意率。结果 咪唑安定组感觉和运动神经阻滞时间显著延长（P<0.01），术者和患者对麻醉的满意率提高(P<0.05)。咪唑安定组有效镇痛时间也显著延长(P<0.001)。两组血流动力学、不良反应情况差别无显著性。结论 咪唑安定加入布比卡因能显著延长麻醉作用时间，麻醉效应增强，而不良反应未见增加。
【关键词】 咪唑安定；布比卡因；蛛网膜下腔麻醉
【Abstract】 Objective To investigate the effect of adding midazolam to intrathecal bupivacaine on the duration and quality of spinal blockade.Methods Forty ASA Ⅰ patients undergoing hysterectomy were selected for the study. The patients were randomly allocated to receive 2.5ml of 0.5% hyperbaric bupivacaine intrathecally with either 0.2ml 0.9%NS or midazolam(1mg) using a combined spinal epidural technique. The duration and quality of sensory and motor block， perioperative analgesia， hemodynamic changes， and sedation levels were assessed.Results The duration of sensory block (time to regression to the S2 segment) was significantly longer in the midazolam group than the control group (218±27 min vs. 165±45 min；P<0.001). The duration of motor block was also prolonged in the midazolam group as compared with the control group (225±45 min vs. 180±30 min；P<0.01). 90% of the patients in the midazolam group， the quality of block was adequate during the intra-operative period as compared with only 65% of the patients in the control group (P<0.05). The duration of effective analgesia was longer in the midazolam group than in the control group (199±14 min vs.103±5 min； P<0.001). Blood pressure， heart rate， oxygen saturation and sedation scores were comparable in both groups.Conclusion The addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anaesthesia and provides prolonged perioperative analgesia without significant side-effects.
【Key words】 midazolam；bupivacaine；spinal anesthesia
咪唑安定加入局麻药物用于硬膜外麻醉能够改善麻醉质量［1，2］。本研究观察咪唑安定加入布比卡因用于蛛网膜下腔麻醉对感觉和运动神经阻滞程度和术后镇静时间的影响。
1 资料与方法
1.1 一般资料 选择我院ASA Ⅰ级，年龄35～56岁，体重51～67kg，无蛛网膜下腔麻醉禁忌证的子宫切除病人40例随机分为对照组和咪唑安定组（试验组），每组各20例。
1.2 麻醉方法 所有病人进入手术室前30min肌注苯巴比妥钠0.1g、阿托品0.5mg。开放上肢静脉通道，蛛网膜下腔注药前20min内静脉输入中分子羟乙基淀粉500ml（贺斯，北京费森尤期卡比药业公司）扩容。蛛网膜下腔麻醉：病人右侧卧位，选择L2～3间隙为穿刺点。17G穿刺针（BD Durasafe一次性腰硬联合麻醉包，江苏碧迪医疗器械有限公司）硬膜外穿刺，25G whitacre腰麻针蛛网膜下腔穿刺，见清亮液体流出，回抽见油状回流液，证实腰麻针已进入蛛网膜下腔。20s内将腰麻药注射完毕，退出腰麻针，置入硬膜外导管，改平卧位。如果术中病人疼痛和（或）手术医生认为肌肉松弛不能满足手术要求，硬膜外注入3%氯普鲁卡因。
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