Erb T, Sluga M, Hampl K F, Ummenhofer W, Schneider M C
Department of Anaesthesia, University of Basel, Kantonsspital, Switzerland.
Acta Anaesthesiol Scand. 1998 Jan;42(1):97-101. doi: 10.1111/j.1399-6576.1998.tb05087.x.
In elderly patients undergoing ophthalmic surgery the loss of co-operation due to over-sedation, induced by drugs given preoperatively, may jeopardise the success of microsurgery performed under regional anaesthesia. The aim of this study was to compare the psychotropic effects of bromazepam and clorazepate-dipotassium, two benzodiazepines with predominantly anxiolytic and only weak sedative action.
A randomised, placebo-controlled, double-blind study was designed to include 60 patients, ASA physical status II-III, older than 60 years scheduled for ophthalmic surgery under regional anaesthesia. The patients were randomised to receive either bromazepam (3 mg) or clorazepate-dipotassium (20 mg) or placebo. The study drugs were given at 10 p.m. the night before surgery and 90 min before surgery. Using the State-Trait Anxiety Inventory (STAI), the patient's anxiety was assessed at the end of the preoperative visit, on the next morning before the study drug was given and on arrival at the operating theatre.
Bromazepam induced a marked anxiolytic effect as documented by a significant reduction in the STAI State values after both applications (P<0.01). Clorazepate did not differ from placebo at any evaluation time with regard to the STAI and haemodynamic values. Sedative effects and oxygen saturation (SpO2) were comparable in all groups.
Bromazepam is superior to clorazepate in its anxiolytic action and suitable as preoperative medication in the elderly patient because of lack of overt sedative effects.
在接受眼科手术的老年患者中，术前给予的药物导致过度镇静而失去合作，可能会危及在区域麻醉下进行的显微手术的成功。本研究的目的是比较溴西泮和氯氮卓二钾这两种主要具有抗焦虑作用且仅有微弱镇静作用的苯二氮䓬类药物的精神效应。
设计了一项随机、安慰剂对照、双盲研究，纳入60例年龄超过60岁、ASA身体状况为II - III级、计划在区域麻醉下进行眼科手术的患者。患者被随机分为接受溴西泮（3毫克）、氯氮卓二钾（20毫克）或安慰剂。研究药物在手术前一晚10点和手术前90分钟给予。使用状态 - 特质焦虑量表（STAI），在术前访视结束时、次日早晨给予研究药物前以及到达手术室时评估患者的焦虑程度。
两次用药后，STAI状态值均显著降低，证明溴西泮具有显著的抗焦虑作用（P<0.01）。在STAI和血流动力学值方面，氯氮卓在任何评估时间与安慰剂均无差异。所有组的镇静效果和氧饱和度（SpO2）相当。
溴西泮的抗焦虑作用优于氯氮卓，且由于缺乏明显的镇静作用，适合作为老年患者的术前用药。
