目的 比较超声引导下椎板后阻滞(retrolaminar block,RLB)与局部浸润麻醉在经皮椎间孔镜腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)中的麻醉效果.方法 40例美国麻醉医师协会(ASA)Ⅰ或Ⅱ级择期行PELD手术的患者,随机分为超声引导下椎板后阻滞组(RLB组)和局部浸润麻醉组(C组),每组20例.RLB组由麻醉医师在超声引导下在脊柱旁矢状位平面内行椎板后阻滞,C组由手术医师根据手术定位逐层局部浸润麻醉,所用药物均为0.5％罗哌卡因20 mL.记录入室(T0)、切皮(T1)、穿刺时(T2)、椎间孔成形(T3)、神经减压(T4)、缝合时(T5)VAS评分和Ramsay镇静评分,记录补救镇痛率和患者满意度,以及术中呼吸抑制、心动过速、高血压等不良反应的发生率,记录术前及术后3个月的Oswestry功能障碍指数(ODI)评分.结果 RLB组T2-4时点VAS评分和补救镇痛率显著低于C组(P<0.05),RLB组患者满意度显著高于C组(P<0.05),术中高血压和心动过速的发生率显著低于C组(P<0.05),两组患者术后3个月ODI评分明显低于术前(P<0.05),但组间ODI评分差异无统计学意义(P>0.05).结论 超声引导下椎板后阻滞(RLB)能够为PELD手术提供满意的镇痛效果,不影响下肢运动功能,不良反应少,安全性高.

目的 探讨多元化教学法在麻醉超声培训中的应用价值.方法 2018年6月至2019年12月的接受全程培训并参加结业考核的学员,按照教学方法不同,随机分为对照组和观察组.对照组(n=48)采用传统教学方法,基础部分课时由麻醉科医生使用幻灯片进行授课;观察组(n=47)采用多元混合教学方法,基础部课时分别由解剖教研室老师在标本室讲解并展示神经的解剖走行、分布以及重要结构,由影像科老师分享影像资料的学习历程,结合高分辨率影像资料讲解常见的解剖变异.实践操作的学习形式包括老师演示、小组练习和集体讨论.培训学习的第4天就培训班学习的重点和难点内容进行量化考核.结果 两组学员一般资料(两组年龄、性别、学历,医院级别和初始成绩)的差异无统计学意义(P>0.05);理论考核成绩观察组高于对照组(P<0.05),观察组操作考核成绩显著高于对照组(P<0.01),观察组学员满意度均高于对照组(P<0.05).结论 多学科参与的多元化教学用于麻醉专业医师超声引导下神经阻滞教学,其教学效果优于传统教学方法.

BACKGROUND:This study aimed to observe the effect of internship in a pre-anesthetic clinic on the teaching quality of pre-anesthesia evaluation for undergraduates.METHODS:A total of 120 undergraduates from July 2017 to July 2018 in the anesthesia department of our hospital were randomly divided into two groups: pre-anesthetic clinic internship teaching group (n = 60) and traditional teaching group (n = 60). The knowledge in the pre-anesthesia evaluation teaching chapters was evaluated between the two groups of undergraduates.RESULTS:There were no significant differences in the demographic information between the two groups. The scores in the case analysis and theoretical knowledge test in the pre-anesthetic clinic internship teaching group were significantly higher than those in the traditional teaching group. In addition, the students' satisfaction with the curriculum design was significantly higher in the pre-anesthetic clinic internship teaching group than in the traditional teaching group.CONCLUSION:Pre-anesthetic clinic internships can improve the quality of pre-anesthesia assessment teaching for undergraduates.

目的 探讨PBL联合CBL教学法在麻醉科住院医师规范化培训教学中的应用.方法 选取2017年9月—2018年9月40名麻醉专业规培学生作为研究对象,随机分为两组,每组20名,实验组(A组)实施PBL联合CBL教学模式,对照组(B组)实施传统教学模式,对两组规培学员的教学效果进行比较和统计分析.结果 A组规培学员的综合考试成绩高于B组(P<0.05),A组规培学员对教学模式评分高于B组(P<0.05).结论 PBL联合CBL教学法在麻醉科规培教学中效果突出,有助于激发学生的学习兴趣、提高学生自主学习能力和临床思维能力.

Objective:To investigate the safety of painless colonoscopy in the treatment of obese patients during high-flow nasal cannula oxygen therapy.Methods:A total of 100 obese patients, ASA Ⅰ?Ⅲ, BMI≥28 kg/m 2, who underwent painless colonoscopy in the First Affiliated Hospital of Xi'an Jiaotong University were selected. According to the random number table method, the patients were divided into two groups ( n=50): an experimental group (group H, who received high-flow nasal cannula oxygen therapy, at an oxygen flow of 20?60 L/min) and a control group (group C, who underwent conventional oxygen inhalation via nasal catheter, at an oxygen flow of 3-5 L/min). Then, their mean arterial pressure (MAP), heart rate and saturation of pulse oximetry (SpO 2) at T0 (immediately after entry into operation room), T1 (1 min after colonoscope insertion), T2 (when insertion of the tip of the colonoscope into the terminal ileum) and T3 (immediately before hospital discharge) were recorded. Furthermore, the incidence of emergency management, the total dosage of propofol, the length of colonoscopy procedure, the awakening time, adverse reactions, and the satisfaction of endoscopists and patients were also recorded. Results:There was no significant difference between group H and group C in general condition, the incidence of adverse reactions, the total dosage of propofol, the length of endoscopic examination and recovery time ( P>0.05). Group H produced remarkable increases in SpO 2 at T1 compared with group C ( P<0.05). There were 11 cases (22%) of emergency treatment for group H, which were significantly lower than 33 cases (66%) in group C ( P<0.05). The satisfaction of both endoscopists and patients from group H was significantly higher than that of group C ( P<0.05). Conclusions:High-flow nasal cannula oxygen therapy can improve the safety of painless colonoscopy examination in obese patients.

目的 评价SP联合PBL、CBL教学模式在本科生麻醉前评估教学中的应用效果.方法 选取2018年-2019年麻醉本科实习学生100名,随机分为SP联合PBL、CBL教学组(A组,n=50)和传统教学组(B组,n=50),通过综合考试成绩和问卷调查对两组学生的教学效果进行比较和统计分析.结果 A组学生的理论知识成绩(37.23±9.43)显著高于B组(20.17±3.56) (P＜0.05);A组学生的病例分析成绩(49.76±13.78)显著高于B组(23.52±8.66) (P＜0.05);A组学生的教学满意度(96％)显著高于B组(24％)(P＜0.05);A组教学模式对激发学生学习兴趣,增强知识理解力、提高临床思维能力、增强沟通协作能力和提高实践操作能力显著高于B组(P＜0.05).结论 SP联合PBL、CBL教学模式相对于传统教学模式在本科生麻醉前评估教学中,更有利于激发学生的学习兴趣、提高学生的沟通协作能力和临床思维能力,教学效果更佳.

目的 探讨七氟烷复合瑞芬太尼与丙泊酚复合瑞芬太尼麻醉对老年腹腔镜胆囊切除术患者血流动力学的影响及麻醉效果.方法 选取2018年1-12月于西安交通大学第一附属医院行腹腔镜胆囊切除术治疗的老年患者156例,应用随机数字表法分为对照组和观察组,各78例.对照组在常规麻醉基础上使用七氟烷复合瑞芬太尼麻醉,观察组在常规麻醉基础上使用丙泊酚复合瑞芬太尼麻醉.比较2组患者麻醉期间血流动力学变化情况(诱导前、插管时和拔管时收缩压、舒张压和心率)、术后恢复情况(呼之睁眼时间、恢复膝跳反射时间和拔管时间)、手术前后认知情况和患者意识[简易精神状态检查量表(MMSE)评分、观察者警觉镇静量表(OAA/S)评分]、苏醒期躁动情况和焦虑程度(Ramsay镇静评分、Riker镇静和躁动评分)和麻醉用药满意度.结果 观察组插管时和拔管时收缩压、舒张压和心率均低于对照组,术后呼之睁眼时间、恢复膝跳反射时间、拔管时间均早于对照组[(5.3±2.3)min比(11.4±4.2)min、(6.3±2.7)min比(10.5±5.3)min、(7±5)min比(14±4)min],术后6 h MMSE量表评分高于对照组[(29.5±3.6)分比(23.5±3.7)分],喉罩拔除后1、3 min时OAA/S评分高于对照组[(4.6±0.8)分比(3.8±0.6)分、(4.8±0.5)分比(3.7±0.6)分],苏醒时和苏醒后30 min的Riker镇静躁动评分低于对照组、Ramsay镇静评分高于对照组,麻醉用药的满意度高于对照组[92.3％(72/78)比75.6％ (59/78)],差异均有统计学意义(均P＜0.05).结论 在老年患者腹腔镜胆囊切除术中给予丙泊酚复合瑞芬太尼麻醉,能够较好地维持患者血流动力学稳定性及镇静效果,患者苏醒时间更短,恢复情况及麻醉感觉更为良好.

Introduction Oral squamous cell carcinoma (OSCC) is the most prevalent malignancy affecting the oral cavity and is associated with severe morbidity and high mortality. 1, 6-O, O-Diacetylbritannilactone (OODBL) isolated from the medicinal herb of Inula britannica has various biological activities such as anti-inflammation and anti-cancer. However, the effect of OODBL on OSCC progression remains unclear. Here, we were interested in the function of OODBL in the development of OSCC. Methods The effect of OODBL on OSCC progression was analyzed by MTT assays, colony formation assays, transwell assays, apoptosis analysis, cell cycle analysis, and in vivo tumorigenicity analysis. The mechanism investigation was performed by qPCR assays, Western blot analysis, and luciferase reporter gene assays. Results We found that OODBL inhibits the proliferation of OSCC cells in vitro. Moreover, the migration and invasion were attenuated by OODBL treatment in the OSCC cells. OODBL arrested cells at the G0/G1 phase and induced cell apoptosis. OODBL was able to up-regulate the expression of LXRα, ABCA1, and ABCG1 in the system. In addition, OODBL activated LXRα/ABCA1 signaling by targeting miR-1247-3p. Furthermore, the expression levels of cytochrome c in the cytoplasm, cleaved caspase-9, and cleaved caspase-3 were dose-dependently reduced by OODBL. Besides, OODBL increased the expression ratio of Bax to Bcl-2. Moreover, OODBL repressed tumor growth of OSCC cells in vivo. Discussion Thus, we conclude that OODBL inhibits OSCC progression by modulating miR-1247-3p/LXRα/ABCA1 signaling. Our finding provides new insights into the mechanism by which OODBL exerts potent anti-tumor activity against OSCC. OODBL may be a potential anti-tumor candidate, providing a novel clinical treatment strategy of OSCC.

目的 比较瑞芬太尼和咪达唑仑用于ICU患者治疗过程中镇痛的临床效果.方法 收集行冠状动脉手术和(或)心脏瓣膜手术的患者72例,随机分为对照组33例和试验组39例.试验组患者使用瑞芬太尼+丙泊酚麻醉,对照组患者使用咪达唑仑+芬太尼麻醉.比较2组患者临床治疗过程中麻醉效果的起效时间、持续时间和镇痛作用.结果 试验组患者麻醉开始时间至减药时间、麻醉开始时间至拔管时间、拔管时间至ICU出院时间和麻醉开始时间至ICU出院时间均显著低于对照组(P<0.05).试验组患者麻醉过程及麻醉后战栗、疼痛、心动过速、呼吸功能不全及低血压等不良反应的发生情况显著小于对照组(P<0.05).试验组麻醉诱导后2 min、气管插管后2 min、手术开始20 min及拔管时心率(HR)均显著低于对照组(P<0.05);试验组患者麻醉诱导后2 min、气管插管后2 min、手术开始20 min以及拔管时试验组的Ramsay评分均显著高于对照组(P<0.05);试验组患者麻醉诱导后2 min、气管插管后2 min、手术开始20 min以及拔管时的平均动脉压(MAP)均显著低于对照组(P<0.05).结论 ICU治疗患者在麻醉的过程中,相比于使用咪达唑仑/芬太尼的患者,使用瑞芬太尼/丙泊酚麻醉的患者麻醉起效时间较快,持续时间较短,镇痛作用较好,能够在ICU患者在治疗过程中发挥良好的镇痛、镇静效果.

BackgroundMillions of people suffered from neuropathic pain, which is related to neuroinflammation in the central nervous system. Penehyclidine hydrochloride is a premedication of general anesthesia, which has been confirmed possessing neuroprotective effects against various neurodegenerative or neuroinflammatory diseases. However, it is not clear that whether penehyclidine hydrochloride could suppress neuropathic pain through its anti-neuroinflammatory effects. MethodsThis study investigated the effects of penehyclidine hydrochloride on rat spinal nerve ligation injury-induced neuropathic pain with behavioral, morphological, and molecular biological methods in animals. ResultsThe results indicated that penehyclidine hydrochloride could attenuate spinal nerve ligation-induced neuropathic pain without any motor impairment and had no effect on sham-operated animals after repeated intraperitoneal administration. Intraperitoneal penehyclidine hydrochloride could suppress spinal nerve ligation-induced ipsilateral spinal dorsal horn microglial activation with downregulation of OX42 expression. Moreover, intraperitoneal penehyclidine hydrochloride inhibited spinal nerve ligation-induced spinal p-p38 mitogen-activated protein kinase expression, which was specially colocalized with the spinal dorsal horn microglia. Furthermore, intraperitoneal penehyclidine hydrochloride could depress spinal neuroinflammation by suppressing spinal nerve ligation-induced interleukin (IL)-1β over-expression. ConclusionThese results indicated that the anti-allodynic effects of penehyclidine hydrochloride on spinal nerve ligation-induced neuropathic pain did not rely on motor impairment. Inhibiting spinal microglial p-p38/IL-1β pathway activation might contribute to the anti-allodynic effect of penehyclidine hydrochloride on nerve injury-induced neuropathic pain.

目的 探讨联合应用托烷司琼和地塞米松预防女性患者无痛胃镜诊疗后恶心、呕吐的效果.方法 将333例需行无痛胃镜诊疗的女性患者按随机数字表法分为4组:托烷司琼+地塞米松干预组(TD组)80例、托烷司琼+生理盐水干预组(TS组)86例、地塞米松+生理盐水干预组(DS组)83例、生理盐水干预组(SS组)84例,比较4组无痛胃镜诊疗后24 h内恶心呕吐发生率及离院时间.结果 与SS组比较,TD、TS和DS组患者恶心、呕吐发生率显著降低(P＜0.05),离院时间显著缩短(P＜0.05).TD组患者恶心、呕吐发生率显著低于TS和DS组(P＜0.05),且TD组患者离院时间显著短于TS和DS组(P＜0.05).结论 托烷司琼联合地塞米松可有效预防女性患者无痛胃镜诊疗后恶心呕吐的发生,并缩短离院时间,且其效果明显优于单一药物应用.

目的 对比肥胖患者超声引导下中心静脉穿刺与传统盲穿在临床教学中的示教效果.方法 选取40名无中心静脉穿刺经验的进修医生,将其随机分为两组.实验组行超声引导下中心静脉穿刺教学,对照组行传统盲穿教学,对比两组进修医生的理论考核成绩,穿刺成功率、并发症发生率、穿刺时间以及不同教学方式的满意度.结果 实验组的理论考核成绩高于对照组,差异具有统计学意义(P<0.05);穿刺成功率高于对照组,差异具有统计学意义(P<0.05),并发症发生率低于对照组,差异具有统计学意义(P<0.05),穿刺时间短于对照组,差异具有统计学意义(P<0.05);教学满意度高于对照组,差异具有统计学意义(P<0.05).结论 肥胖患者超声引导下中心静脉穿刺在进修医生的临床教学中效果更加突出.

目的 探讨Toll样受体介导雷公藤甲素(Tw)对外周神经损伤所致神经病理性痛的镇痛作用.方法 将18只SD大鼠随机分为3组:假手术-二甲基亚砜(DMSO)(对照组)和SNL-DMSO组、SNL-TW组,每组6只.对SNL-DMSO组、SNL-TW组大鼠行脊神经结扎手术,建立神经病理性痛动物模型,检测不同干预措施对各组神经病理性痛行为学的影响,并通过免疫荧光组织化学观察大鼠脊髓背角小胶质细胞标记物OX42表达情况.结果 激光共聚焦显微镜下观察显示,对照组脊髓背角小胶质细胞OX42表达较低.SNL-DMSO组脊髓背角小胶质细胞OX42表达升高,SNL-TW组脊髓背角小胶质细胞OX42表达明显低于SNL-DMSO组.与对照组比较,SNL-DM-SO组、SNL-TW组术后3d机械性痛阈均明显降低(P＜0.05);与SNL-DMSO组比较,SNL-TW组术后3d机械性痛阈明显升高(P＜0.05).结论 鞘内注射TW可通过抑制Toll样受体3介导的小胶质细胞活化,从而缓解脊神经结扎导致神经病理性痛的机械性痛觉过敏.

Objective To evaluate the efficacy of nalbuphine in preventing shivering after neuraxial anesthesia in patients undergoing cesarean section.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-35 yr,weighing 55-80 kg,undergoing elective cesarean section under neuraxial anesthesia,were divided into nalbuphine group (group N,n=40) and control group (group C,n=40) using a random number table method.After delivery,nalbuphine 0.1 mg/kg was intravenously injected immediately before clamping the umbilical cord in group N,and the equal volume of normal saline was given instead in group C.Ramsay sedation score was recorded before giving nalbuphine,at 5 min after giving nalbuphine,and at the end of surgery.The development of shivering was recorded from the end of nalbuphine administration until the end of surgery,and the shivering intensity was estimated using Wrench grading.The development of over-sedation,nausea and vomiting,bradycardia,hypotension and dizziness was recorded from the end of nalbuphine administration until the end of surgery.Results Compared with group C,Ramsay sedation scores were significantly increased at 5 min after giving nalbuphine and at the end of surgery,the incidence of shivering was decreased,the shivering intensity was reduced (P＜0.05),and no significant change was found in the incidence of adverse reactions in group N (P＞ 0.05).Conclusion Nalbuphine can prevent the occurrence of shivering after neuraxial anesthesia in patients undergoing cesarean section.

Objective To study the influence factors and intervention measures of the medication compliance in patients with hypertension.Methods 404 cases of hypertensive patients in neurology from March 2013 to December 2014 were selected and a retrospective medical record access and telephone follow-up conversations were made to investigate and analyze medication compliance.Results Among the 404 cases,142 with good medication compliance,and the rate was 35.15%;262 with poor medication compliance,and the rate was 64.85%.Logistic regression analysis showed that gender,occupation,hypertension duration,accompanies chronic diseases,and discharge time had a close relationship with patient medication compliance.Conclusion Hypertensive patients had poor medication compliance,which were influenced by many factors.Clinical pharmacists should implement targeted interventions and play an active pharmaceutical service to improve medication compliance.

Objective To compare the blood-saving effect when acute hypervolemic hemodilution (AHH) was performed with hydroxyethyl starch (HES) 130/0.4 dissolved in electrolyte injection (HES-E) and HES 130/0.4 in sodium chloride injection (HES-NaCl).Methods Thirty patients of both sexes,aged 18-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with body mass index of 18-25 kg/m2,hemoglobin (Hb) ＞100 g/L,hematocrit (Hct) ＞ 35％,scheduled for elective abdominal operations under general anesthesia,were randomly divided into HES-E group and HES-NaCl group using a random number table,with 15 patients in each group.AHH was performed after induction of anesthesia.In HES-E and HES-NaCl groups,HES-E and HES-NaCl 15 ml/kg were intravenously infused over 30 min,respectively,and the infusion was conpleted before skin incision.Immediately after onset of AHH (T1),at 2 h after the end of AHH (T2),and at the end of operation (T3),arterial blood samples were collected for blood gas analysis and blood routine test,and pH value,base excess,HCO3-,K+,Na+,Cl-,Ca2+,Hb and Hct were recorded.Venous blood samples were collected at T1 and T2 for measurement of blood coagulation parameters including prothrombin time,activated partial thromboplastin time and fibrinogen and thrombelastography parameters.The volume of liquid intake and output and requirement for allogeneic blood transfusion were recorded,and the blood volume expansion rate was calculated.Results Compared with group HES-NaCl,no significant changes were found in the total volume of liquid infused,requirement for allogeneic blood transfusion,blood volume expansion rate,blood coagulation parameters at each time point,Hb and Hct (P＞0.05),pH value,base excess,HCO3 and K+ were significantly increased,and Na+ and Cl-were significantly decreased in group HES-E (P＜0.01).Conclusion There is no significant difference in the blood-saving effect between AHH with HES-E and HES-NaCl clinically,but HES-E can maintain homeostasis better.

Objective To investigate different chrysin solid preparation dissolution in vitro and to establish an HPLC method for the determination of dissolution .Method The dissolution of three chrysin solid preparations were evaluated in 40% and 50% ethanol , 5 g?L -1 sodium dodecyl sulfate solution ,and 10 g?L -1 sodium dodecyl sulfate solution ,respectively .The HPLC method for determination of the chrysin dissolution was carried out on a C18 column using methanol-phosphoric acid-water (65∶ 35) as a mobile phase .The detection wavelength was at 256 nm ,the flow rate was 1 .0 mL?min-1 ,and the temperature of column was 30℃ .Results 10 g?L -1 sodium dodecyl sulfate solution as a dissolution medium is suitable for evaluating the three chrysin solid preparations in this study .In addition ,the dissolution quality standards of chrysin solid preparation were discussed .Conclusion The dissolution of three chrysin solid preparations showed significant difference and the dissolution of micronized chrysin solid preparations was significantly improved .

Objective To research the preparation method and release behavior of Curcumin Sustained Tablets .Methods The HPLC quantitative analysis was performed on an XTerra C18 column (150 mm × 4 .6 mm ,5 μm) with methanol and 50 mL · L -1 glacial acetic acid solution (60∶40) as the mobile phase at a flow rate of 1 .0 mL · min-1 .The detection wavelength was 420 nm and the column temperature was at 30 ℃ .Results The calibration curve showed good linearity ranged from 0 .003 6 to 0 .036 mg · mL -1 . The average recovery was 98 .9% and RSD was 1 .2% .Curcumin released from the tablets were more than 80% at 8 h . Conclusion The release performance of Curcumin Sustained Tablets is good ,and the analytical method is accurate and reliable , which can be used as an evaluation method for the release of Curcumin Sustained Tablets .

Objective To determine the contents of chlorogenic acid and phillyrin in 2 honeysuckle compound preparations simultane‐ously by HPLC .Methods The samples were separated on a Phenomenex‐C18 (250 mm × 4 .6 mm ,5 μm) chromatographic column using acetonitrile‐1 .0 mL · L -1 phosphoric acid solution as a mobile phase with a gradient elution .The detection wavelength was at 326 nm (chlorogenic acid) or 228 nm (phillyrin) ,the flow rate was 1 .0 mL · min-1 ,and the temperature of column was 30 ℃ . Results The linear range of chlorogenic acid was 0 .010‐0 .100 mg · mL -1 (r = 0 .999 7) ,and the average recoveries were more than 98 .0% ;the linear range of phillyrin was 0 .001‐0 .010 mg · mL -1 (r= 0 .999 8) ,and the average recoveries were more than 97 .0% .The contents of chlorogenic acid and phillyrin in Yinqiao Jiedu Tablets were 0 .546 and 0 .040 mg · tablet-1 ,respectively ;The contents of chlorogenic acid and phillyrin in Compound Lonicera Granules were 2 .550 and 0 .223 mg · bag-1 ,respectively .Conclu‐sion The method is sensitive ,accurate ,and can be used to control the quality of the 2 honeysuckle compound preparations .

Objective To study the sedation and amnesia of midazolam in patients with different ages of lumbar epidural anesthesia . Methods From January to July 2015, 235 patients in the first affiliated of xian jiaotong unniversity,who were implemented abdominal surgery under combined spinal epidural anesthesia and American Society of anesthesiologists (ASA) grade was I-II , were divided into three groups:young group (n=70); middle-aged group (n =82); elderly group (n =83).Intraoperative continuous monitoring of respiratory and circulatory function index,and recorded MAP,SpO2, HR before and 5, 15, 30 min after injection.ResuIts MAP, HR and SpO2 of three groups were compared with the same time points pre-and post used of midazolam, there was no significant difference among indicators.; Compared with the same group at different time points, MAP(FYG =9.2547,FMG =12.8181,FOG =17.77)和 SpO2 (FYG =190.3835,FMG =196.2393,FOG =270.5609),there were significant difference.The difference was not statistically significant between HR group and the same group at different time points and forgetting degree and sedation score , but compared with OG,there were significant difference(P<0.05).The total number of adverse reactions in YG group and MG group was less than that of OG group(X2 =11.2516,X2 =10.4491, P<0.05).ConcIusion The effect of the same dose of midazolam on sedation and amnesia in patients with different ages of lumbar epidural anesthesia is different, and the degree of the effect of the elderly patients is significant,but will produce more adverse reactions.Therefore, in the combined spinal epidural anesthesia,it is necessary to consider the patient's individual differences, rational use of sedative and narcotic drugs.