CAJ | 학술논문

目的：比较右美托咪定和咪唑安定对焦虑患者记忆功能的影响。方法60例择期在腰硬联合麻醉下行下腹部或下肢手术且焦虑评分＞30 mm的患者，随机等分为4组（n＝15）：右美托咪定（dexmedetomidine， DXM）0．5μg·Kg-1组（D0．5组）、右美托咪定1μg·Kg-1组（D1组）、咪唑安定组（M组）和对照组（C组）。各组分别在L2/3间隙穿刺麻醉，麻醉平面固定后，分别于10 min内泵注DXM 0．5μg·Kg-1、DXM 1μg·Kg-1、咪唑安定0．07 mg·Kg-1和生理盐水10 mL。评估各组患者术前及用药前、用药后30 min的焦虑、镇静程度及记忆情况以及手术结束后4小时的记忆情况。记录并比较4组患者术中的平均压（MBP）、心率（HR）、血氧饱和度（SpO2）、呼吸次数（RR）等。结果 D0．5、D1及M组用药后均有一定程度的镇静作用，焦虑程度均较术前明显减轻（P＜0．05）。与对照组相比，D0．5、D1、M组均有顺行性遗忘作用（P＜0．05），D1组顺行性遗忘程度明显高于D0．5组（P＜0．05），与M组相当（P＞0．05）。用药后D0．5、D1组MBP和HR低于M、C组（P＜0．05）。各组RR无明显差异（P＞0．05），而M组有2人SpO2下降至94％以下。结论右美托咪定对焦虑患者有明显的镇静、抗焦虑作用，对记忆的影响与剂量有关。1μg·Kg-1右美托咪定的顺行性遗忘作用与咪唑安定0．07 mg·Kg-1相当。
목적：비교우미탁미정화미서안정대초필환자기억공능적영향。방법60례택기재요경연합마취하행하복부혹하지수술차초필평분＞30 mm적환자，수궤등분위4조（n＝15）：우미탁미정（dexmedetomidine， DXM）0．5μg·Kg-1조（D0．5조）、우미탁미정1μg·Kg-1조（D1조）、미서안정조（M조）화대조조（C조）。각조분별재L2/3간극천자마취，마취평면고정후，분별우10 min내빙주DXM 0．5μg·Kg-1、DXM 1μg·Kg-1、미서안정0．07 mg·Kg-1화생리염수10 mL。평고각조환자술전급용약전、용약후30 min적초필、진정정도급기억정황이급수술결속후4소시적기억정황。기록병비교4조환자술중적평균압（MBP）、심솔（HR）、혈양포화도（SpO2）、호흡차수（RR）등。결과 D0．5、D1급M조용약후균유일정정도적진정작용，초필정도균교술전명현감경（P＜0．05）。여대조조상비，D0．5、D1、M조균유순행성유망작용（P＜0．05），D1조순행성유망정도명현고우D0．5조（P＜0．05），여M조상당（P＞0．05）。용약후D0．5、D1조MBP화HR저우M、C조（P＜0．05）。각조RR무명현차이（P＞0．05），이M조유2인SpO2하강지94％이하。결론우미탁미정대초필환자유명현적진정、항초필작용，대기억적영향여제량유관。1μg·Kg-1우미탁미정적순행성유망작용여미서안정0．07 mg·Kg-1상당。
Objective To compare the effects of dexmedetomidine and midazolam on memory in patients with anxiety. Methods Sixty patients with Anxiety Visual Analog Test (AVAT)>30 mm, ASA Ⅰor Ⅱ,who were scheduled for hypogastrium and lower limbs surgery under combined spinal-eunder anesthesia were randomly divided into four groups (n=15,each group): dexmedetomidine (DXM) 0.5 μg·Kg-1 group (group D0.5), DXM 1 μg·Kg-1 group (group D1), midazolam group (group M) and saline group (group C). After spinal anesthesia in L2/3, patients were infused intravenously with dexmedetomidine at 0.5 μg·Kg-1 in Group D0.5,1 μg·Kg-1 in group D1, midazolam at 0.07 mg·Kg-1 in group M and saline 10 ml in group C over 10 minutes..AVAT, Rasmay score and memory function were evaluated at preoperation,.before and thirty minutes after drug infusion. Memory function were evaluated again 4 hours after operation. Mean blood pressure (MBP), heart rates (HR), SpO2,. respiratory rates (RR)of patients during operation were recorded..Results Patients in groups of D0.5,.D1 and M had significant sedation and decrease in anxiety after drug infusion when compared to preoperation(P<0.05 for all groups),and also had anterograde amnesia effect compared to group C (P<0.05 for all groups). The degree of anterograde amnesia in group D1 was significantly higher in group D1 than that in group D0.5 (P<0.05), but was the same to that in group M (P>0.05)..MBP,.HR in groups of D0.5 and D1 were lower than those in group M and group C..The respiratory rates had no significant difference among all groups. However,.two patients in group M had a decrease in SpO2 below 94%. Conclusion Dexmdetomidine has significant effects on antianxiety and sedation, and has an anterograde amnesia in patients with anxiety. The degree of anterograde amnesia at dexmedetomidine 1 μg·Kg-1 has the same effect as 0.07 mg·Kg-1 of midazolam.