丙泊酚与咪达唑仑用于全麻后苏醒室躁动疗效的比较

目的:比较丙泊酚及咪达唑仑用于全麻后苏醒室(post-anesthesia care unit,PACU)躁动的疗效。方法:本研究选取2016年11月至2020年4月全麻术后转入PACU后发生中、重度躁动的患者194例,分为丙泊酚组(P组,n=98)、咪达唑仑组(M组,n=96)。P组静脉注射丙泊酚0.5 mg/kg~1 mg/kg,M组静脉注射咪达唑仑0.03 mg/kg。必要时重复给药,直至患者Riker镇静和躁动评分在4分及以下。记录两组患者给药次数、药物起效时间、给药前后Riker评分、PACU停留时间、给药前、末次给药后生命体征及处理方法。结果:首次给药后,两组患者躁动均可得到缓解,Riker评分差异无统计学意义(P>0.05)。P组48例患者缓解后躁动再次加重,重复给药后38例可渐缓解,另10例仍需制动。M组12例患者躁动缓解后再次加重,重复给药后均可渐缓解。两组患者首次给药后躁动缓解后再次加重的症状差异具有统计学意义(P<0.05),PACU停留时间差异无统计学意义(P>0.05)。其中P组7例患者重复给药后呼吸抑制予托下颌面罩供氧后可快速缓解,M组重复给药后3例患者呼吸抑制需放置口咽通气道。结论:咪达唑仑用于PACU躁动较丙泊酚不易反复发作,但重复给药后引起的呼吸抑制需被重视。

Comparison of the Effects of Propofol and Midazolam on Postoperative Agitation in Post-anesthesia Care Unit

Objective: To compare the effects of propofol and midazolam on emergence agitation in post-anesthesia care unit(PACU). Methods: 194 patients with moderate or severe agitation in PACU after general anesthesia from November 2016 to April 2020 were selected. The patients were divided into two groups: Group Propofpl(Group P, n=98) and Group Midazolam(Group M, n=96). Patients in Group P received intravenous 0.5 mg/kg~1 mg/kg propofol and patients in Group M received intravenous 0.03 mg/kg midazolam for treatment. Repeat the medication if necessary, until the Riker score is less than or equal to 4. Administration times, efficacy time, Riker scores before and after administration, PACU residence time, vital signs before the first and after the last administration, and the treatment were recorded. Results: Agitation was relieved in both groups after the first administration, there was no significant difference in Riker score difference(P>0.05). 48 patients in Group P showed recurrence agitation and 38 patients of them required second administration, another 10 of them still needed to be bound after the last administration. 12 patients in Group M showed recurrence and were gradually relieved after repeated administration. The difference of the recurrence situation between Group M and Group P was significant(P<0.05),and there was no significant difference in PACU residence time(P>0.05). 7 patients in Group P needed jaw thrust maneuvers and oxygen masks, and 3 patients in Group M needed inserting oropharyngeal airways for respiratory depression after repeated administration.Conclusions: The treatment of midazolam for agitation in PACU had less recurrence than propofol, however, great importance should be attached to its respiratory depression effect.