咪达唑仑诱导对老年患者腹腔镜胆囊切除术后苏醒质量的影响

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (2): 196-199.

咪达唑仑诱导对老年患者腹腔镜胆囊切除术后苏醒质量的影响

仲俊峰, 胡双燕, 蒋宗明

浙江省绍兴市人民医院麻醉科,绍兴 312000,浙江

收稿日期:2010-12-02 修回日期:2011-02-12 发布日期:2011-04-20
通讯作者: 蒋宗明,男,主治医生,硕士,从事临床麻醉工作。Tel: 13515852725 E-mail: jiangzhejiang120@163.com
作者简介:仲俊峰,男,主治医生,学士,从事临床麻醉工作。Tel: 13777312712 E-mail: zhongjunfeng800@126.com

Effects of induction with midazolam on postoperative anesthesia recovery quality in aged patients received laparoscopic cholecystectomy

ZHONG Jun-feng, HU Shuang-yan, JIANG Zong-ming

Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang,China

Received:2010-12-02 Revised:2011-02-12 Published:2011-04-20

摘要/Abstract

摘要： 目的:观察咪达唑仑诱导对老年患者腹腔镜胆囊切除全身麻醉后苏醒质量的影响。方法: 择期行腹腔镜胆囊手术老年患者54例,65～75岁,ASAⅠ～Ⅱ级,随机分为试验组和对照组,每组27例。试验组予咪达唑仑 0.05 mg/kg、异丙酚 0.6～0.8 mg/kg、芬太尼 4 μg/kg、阿曲库铵 0.7 mg/kg 诱导。对照组予异丙酚1～1.5 mg/kg、芬太尼 4 μg/kg、阿曲库铵 0.7 mg/kg 诱导,气管插管后行机械通气,术中异丙酚、七氟醚维持麻醉。观察记录下列指标:诱导前即刻(T₀)、插管后1 min(T₁)、腹腔充气时(T₂)、手术结束时(T₃)、拔管时(T₄)、拔管后 1 min(T₅)、5 min(T₆)、10 min(T₇)的SBP、DBP和HR;手术结束后患者睁眼时间;气管导管拔出时间;麻醉恢复室(PACU)停留时间;术后完全清醒时间;拔管后不良反应;拔管后 10 min Ramsay评分。结果: 与对照组比较,试验组睁眼时间、拔管时间明显延迟(P＜0.05);拔管后呼吸抑制、舌根后坠和嗜睡的发生率明显增加(P＜0.05);拔管 10 min 后Ramsay评分3～4级例数明显增多(P＜0.05)。两组 T₄、T₅时SBP、DBP、HR较 T₀均明显升高,两组间差异有统计学意义(P＜0.05)。结论:咪达唑仑可能导致老年患者苏醒延迟,增加拔管后呼吸抑制和嗜睡等不良反应的发生率。

关键词: 咪达唑仑, 老年, 麻醉,全身, 苏醒质量

Abstract: AIM: To evaluate the effects of induction with midazolam on postoperative anesthesia recovery quality in aged patients received laparoscopic cholecystectomy.METHODS: 54 ASAⅠ-Ⅱelderly patients aged 65-75 years undergoing elective laparoscopic cholecystectomy were randomly divided into 2 groups(n=27); experimental group(Group M) and control group(Group P).Midazolam 0.05 mg/kg, propofol 0.6-0.8 mg/kg, fentanyl 4 μg/kg and atracurium 0.7 mg/kg were intravenously administered during induction in Group M,wheareas in Group P ,anesthesia was induced with propofol 1-1.5 mg/kg, fentanyl 4 μg/kg and atracurium 0.7 mg/kg. The patients were mechanically ventilated.Anesthesia was maintainded with propofol and sevoflurane. The SBP,DBP and HR were recorded immediately before anesthesia induction (T₀),1 min after intubaion (T₁), pneumopetitonium (T₂),at the end of surgery(T₃),immediately and 1 min,5 min,10 min after extubation (T_4,5,6,7). Times of open eyes,extubation,staying at PACU and being wide awake were recorded. Adverse events after extubation and Ramsay score 10 minutes after extubation were observed.RESULTS:Compared with Group P, the time of open eyes and extubation were significantly prolonged(P＜0.05) and the rates of post-extubation respiratory depression, glossoptosis and drowsiness were significantly increased in Group M(P＜0.05).The number of samples of Ramsay score grade 3 or 4 at 10 min after extubation in Group M was increased(P＜0.05).The SBP,DBP and HR at T₄ ,T₅ were obviously increased than those at T₀ in the two groups.There was statistically difference between the two groups (P＜0.05).CONCLUSION: Midazolam might result in postoperative recovery delay in elderly patients, and it could increase the rate of post-extubation respiratory depression,glossoptosis and drowsiness.

Key words: Midazolam, Aged, Anesthesia, General, Recovery quality

中图分类号:

R614.2

仲俊峰, 胡双燕, 蒋宗明. 咪达唑仑诱导对老年患者腹腔镜胆囊切除术后苏醒质量的影响[J]. 中国临床药理学与治疗学, 2011, 16(2): 196-199.

ZHONG Jun-feng, HU Shuang-yan, JIANG Zong-ming. Effects of induction with midazolam on postoperative anesthesia recovery quality in aged patients received laparoscopic cholecystectomy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(2): 196-199.

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