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目的 观察咪唑安定或丙泊酚伍用芬太尼对镇静和呼吸、循环的影响,探讨脑电双频 指数(BIS)与呼吸、循环参数的关系。方法 选择行四肢或下腹部手术患者40例,随机均分为四组: 丙泊酚组(P组)、丙泊酚加芬太尼组(PF组)、咪唑安定组(M组)和咪唑安定加芬太尼组(MF组)。 静注芬太尼0.05mg(1ml)或生理盐水1ml(观察者不知);丙泊酚负荷量1mg/kg,维持量0.05mg ·kg 1·min 1;咪唑安定负荷量0.1mg/kg,维持量0.01mg·kg 1·min 1。观察并每隔2分钟记录 患者呼吸指标(PETCO2、PaO2、PaCO2、SaO2等)及循环指标,并与BIS、95%边缘频率(95%SEF)和警 觉/镇静观察评分(OAA/S)进行相关分析。结果 观察期间各组无因循环指标达到“黄牌”而停药, 均因呼吸指标达到“黄牌”而停止给药。BIS与用药剂量呈负相关,与OAA/S和95%SEF呈正相关, BIS与PaCO2、PETCO2和RR呈负相关,与VT、VE、SpO2、SaO2呈正相关,PF组HR比P组慢(P< 0.01)。MF组的PETCO2、RR及HR与M组有明显变化(P<0.01)。结论 本研究条件下最合适 的镇静水平维持OAA/S评分2～3分、BIS72～80为宜,此时呼吸、血液动力学稳定,对手术刺激无 反应且能产生遗忘,同时对呼吸、循环抑制较轻。
Objective To observe the effects of midazolam or propofol combined with fentanyl on the sedation, respiration and circulation, and to explore the relationship between bispectral index (BIS) and respiration and circulation parameters. Methods Forty patients with limbs or lower abdomen were randomly divided into four groups: propofol group (P group), propofol plus fentanyl group (PF group), midazolam group (M group) and imidazole Diazepam and fentanyl group (MF group). Intravenous fentanyl 0.05mg (1ml) or normal saline 1ml (unknown to the observer); propofol loading 1mg / kg, maintenance dose 0.05mg · kg 1 · min 1; midazolam loading 0.1mg / kg, maintaining Amount 0.01 mg · kg 1 · min 1. The patient’s respiratory index (PETCO2, PaO2, PaCO2, SaO2, etc.) and the circulatory index were observed and recorded every 2 minutes and were correlated with BIS, 95% SEF and OAA / S analysis. Results During the observation period, no drug was stopped due to the “yellow card” circled the index without stopping due to the “yellow card” of respiratory index. The BIS was negatively correlated with the dose of medication, positively correlated with OAA / S and 95% SEF, BIS was negatively correlated with PaCO2, PETCO2 and RR, and positively correlated with VT, VE, SpO2 and SaO2 <0.01). PETCO2, RR, HR and M group in MF group had significant changes (P <0.01). Conclusion The most appropriate sedation level in this study maintains the OAA / S score of 2 to 3, BIS72 to 80 is appropriate, this time breathing, hemodynamic stability, no response to surgical stimulation and can produce forgotten, while breathing, circulation Inhibit lighter.