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目的:观察丁丙诺啡复合小剂量咪达唑仑能否预防腹式全子宫切除术中的内脏牵拉反应。方法:选择因严重子宫腺肌症、多发性子宫肌瘤等良性病变需要在硬膜外麻醉下施行全子宫切除术患者150例,随机分为丁丙诺啡、咪达唑仑组(A组),芬太尼、氟哌利多组(B组)和哌替啶、氟哌利多组(C组),每组各50例,分别观察3组患者在给药前、切皮、切皮后10 m in、40 m in以及术毕各时点的血流动力学(HR和MAP)、脉搏血氧饱和度(SpO2)、镇静评分(RSS)、术中牵拉反应、药物不良反应及术后患者PCA每小时的药物需要量。结果:C组患者HR在切皮、切皮后10 m in、40m in时明显快于A组或B组(P<0.01);A组的镇静评分在切皮后40 m in、术毕时明显高于B组(P<0.01),C组明显高于B组(P<0.01);C组术中牵拉反射发生例数明显多于A组或B组(P<0.05);术后PCA药量为B组>C组>A组(A组较B组或C组)(P<0.01);3组患者均未见呼吸抑制等不良反应。结论:切皮前静脉注射丁丙诺啡和咪达唑仑可以较安全有效地预防腹式全子宫切除术中牵拉反应,作用时间可维持较长。
Objective: To observe whether buprenorphine combined with low dose midazolam can prevent the visceral traction in abdominal hysterectomy. METHODS: One hundred and fifty patients undergoing total hysterectomy under epidural anesthesia were enrolled in this study. One hundred and fifty patients undergoing selective hysterectomy were randomly divided into two groups: buprenorphine and midazolam (group A) ), Fentanyl, droperidol group (group B) and pethidine, and droperidol group (group C), with 50 cases in each group. Before treatment, Hemodynamics (HR and MAP), SpO2, sedation score (RSS), intraoperative stretch, adverse drug reaction Post-patient PCA hourly medication requirements. Results: The HR of group C was significantly faster than that of group A or group B at 10 m in and 40 m in group C (P <0.01). The sedation score of group A was 40 m after incision, (P <0.01), C group was significantly higher than that of B group (P <0.01). In C group, the number of traction and reflection was significantly more than that of A or B group (P <0.05) PCA dose for the B group> C group> A group (A group than B or C group) (P <0.01); 3 patients were no respiratory depression and other adverse reactions. CONCLUSION: Buprenorphine and midazolam can be used to prevent the stretching reaction in abdominal hysterectomy safely and effectively, and the duration of action can be maintained for a long time.