标题：舒芬太尼联合咪达唑仑用于下肢骨折椎管内麻醉前镇痛的临床效果

      作者：王丽，郝海宁，孟扬，刘峰，任伟荣    (榆林市第一医院麻醉科，陕西 榆林 718000)

      卷次： 2017年28卷15期

      【摘要】 目的 观察舒芬太尼联合咪达唑仑应用于下肢骨折椎管内麻醉前镇痛的临床效果。方法 选择2016年3~10月期间榆林市第一医院收治的126例下肢骨折患者为研究对象，所有患者均采用椎管内麻醉，根据随机数表法将其分为观察组和对照组，每组63例。对照组麻醉前应用咪达唑仑，观察组则联合应用舒芬太尼，比较两组患者术中疼痛程度(VAS评分)及平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)的变化。结果 观察组患者术中，MAP、HR及SPO2在搬运至手术床上后(T2)、体位摆放时(T3)、椎管内穿刺前(T4)与镇痛前(T1)比较差异均无统计学意义(P>0.05)；对照组MAP、HR在T2、T3分别为(100.8±5.7) mmHg和(94.5±3.9)次/min、(103.2±5.6) mmHg和(93.2±3.8)次/min，明显高于观察组的(92.4±3.5) mmHg和(83.4±4.1)次/min、(93.1±4.8) mmHg和(82.1±4.4)次/min，差异均有统计学意义(P<0.05)；观察组患者在T2、T3两个时点VAS评分分别为(4.6±1.9)分、(4.9±2.1)分，明显低于对照组的(7.1±3.4)分、(8.1±3.8)分，差异均有统计学意义(P<0.05)。结论 下肢骨折患者在行椎管内麻醉前应用舒芬太尼联合咪达唑仑可以有效减轻患者疼痛、降低应激反应程度。
      【关键词】 舒芬太尼；咪达唑仑；骨折；椎管内麻醉；应激反应
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2017）15—2465—03

Clinical effect of sufentanil combined with midazolam in lower limb fracture before spinal anesthesia.
WANG Li,HAO Hai-ning, MENG Yang, LIU Feng, REN Wei-rong. Department of Anesthesiology, Yulin First Hospital, Yulin 718000,Shaanxi, CHINA
【Abstract】 Objective To investigate the clinical effect of sufentanil combined with midazolam in lower limbfracture before spinal anesthesia. Methods A total of 126 patients of lower limb fracture, who admitted to our hospitaland underwent spinal anesthesia from March 2016 to October 2016, were selected and divided into the observationgroup and the control group according to the random number table method, with 63 cases in each group. The controlgroup was treated with midazolam before anesthesia, and the observation group was treated with sufentanil combinedwith midazolam. The changes of pain degree (VAS score) and mean arterial pressure (MAP), heart rate (HR), pulse oxy-gen saturation (SpO2) between the two groups were compared. Results Compared with before analgesia (T1), theMAP, HR and SPO2 in the observation group at move to the operating bed after (T2), position positioning (T3), beforespinal puncture (T4) showed no significant difference (P>0.05). The MAP and HR in the control group at T2 and T3 were(100.8±5.7) mmHg and (94.5±3.9) times/min, (103.2±5.6) mmHg and (93.2±3.8) times/min, respectively, which were sig-nificantly higher than (92.4±3.5) mmHg and (83.4±4.1) times/min, (93.1±4.8) mmHg and (82.1±4.4) times/min in the ob-servation group (P<0.05). The VAS score in the observation group at T2 and T3 were respectively (4.6±1.9) and (4.9±2.1), which were significantly lower than (7.1±3.4) and (8.1±3.8) in the control group (P<0.05). Conclusion The applica-tion of sufentanil combined with midazolam before spinal anesthesia for lower limb fracture can effectively relieve painand reduce the stress response.
      【Key words】 Sufentanil; Midazolam; Fracture; Spinal anesthesia; Stress response·论 著·doi:10.3969/j.issn.1003-6350.2017.15.016