摘要
目的比较丙泊酚、咪达唑仑及两药联用在急诊危重病患者机械通气中的镇静效果。方法回顾性分析2007年8月至2011年7月在本院急诊重症监护病房（EICU）接受机械通气同时需要镇静治疗的68例患者临床资料，根据镇静剂种类不同分为丙泊酚组（28例）、咪达唑仑组（20例）、丙泊酚联合咪达唑仑组（联用组，20例）。丙泊酚组和咪达唑仑组按常规镇静方法分别给予负荷量的丙泊酚、咪达唑仑，随后用微量注射泵持续泵入；联用组先以丙泊酚静脉推注诱导镇静，随后以丙泊酚联合咪达唑仑用微量注射泵持续泵入。采用Ramsav镇静分级，3组患者均维持理想的镇静深度2～4级，镇静开始后每1～2h评估1次。观察各组患者用药前后生命体征及呼吸机相关参数的变化，并记录镇静剂及机械通气治疗情况。结果3组患者用药1h后心率（HR）、自主呼吸频率（RR）、收缩压（SBP）、舒张压（DBP）、潮气量（V_T）均较用药前显著降低，脉搏血氧饱和度（SpO2）均较用药前显著升高；RR、SpO2变化程度无显著差异。用药1h，丙泊酚组HR（次／min）、SBP（mmHg，1mmHg=0．133kPa）、DBP（mmHg）降低程度较咪达唑仑组和联用组显著（HR：20．43±13．52比15．27±13．71、18．54±10．07，SBP：39．26±16．64比25．80±21．09、31．50±28．20，DBP：21．35±12．91比14．07±10．53、16．42±13．55，P〈0．05或P〈0．01），联用组V，（m1）降低程度较丙泊酚组和咪达唑仑组显著（121．06±96．50比33．36±28．49、39．94±33．24，均P〈0．01）。联用组镇静剂总用量（mg／奴）较丙泊酚组、咪达唑仑组明显减少（丙泊酚总用量：25．21±15．33比90．83±17．42，咪达唑仑总用量：2．37±1．87比4．02±3．62，均P〈0．01），但3组镇静剂持续应用时间无明显差异。联用组EICU滞留时间（d）较丙？白酚组、咪达唑仑组明显缩短（7．75±5．20比12．53±8．24、15．20±8．33，均P〈0．05），但3组机械通气时间无明显差异。结论丙泊酚联合咪达唑仑用于急诊危重病机械通气患者不仅能达到良好的镇静效果，减少镇静药物的总用量，还能减轻丙泊酚对循环的抑制作用，改善患者人机对抗的症状，缩短在EICU的住院时间。
Objective To compare the sedative effects of propofol and midazolam, or combination of them on emergency critically ill patients on mechanical ventilation. Methods Medical records of 68 patients treated in emergency intensive care unit （EICU） receiving mechanical ventilation and sedation care from August 2007 to July 2011 were reviewed retrospectively. According to the type of sedatives used, patients were assigned to propofol group （n = 28 ）, midazolam group （n = 20 ）, combination of propofol and midazolam group （combination group, n = 20 ）. Patients in the former two groups were given a loading dose of propofol or midazolam and followed by continuous infusion of the same drugs. Those in the combination group were given a loading dose of propofol and followed by continuous infusion of propofol together with midazolam. In this study, Ramsay anesthesia score was used to evaluate the effectiveness of sedation. The patients in three groups were maintained at depth of sedation level 2-4 according to the Ramsay score, and reassessed every 1-2 hours after the initiation. The change in vital signs and respirator related parameters were observed before and after administration in three groups, and the treatment information of sedative and mechanical ventilation were recorded. Results Heart rate （HR）, respiratory rate （RR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, tidal volume （VT） were decreased at 1 hour after treatment compared with those before treatment in all the three groups, while the blood oxygen saturation （SpO2） was increased. There were no significant differences in RR and SpO2 at 1 hour after treatment among three groups. HR （bpm）, SBP （ram Hg, 1 mm Hg=0.133 kPa）, DBP （mm Hg） at 1 hour afler treatment in propofol group were significantly decreased compared with those in midazolam group andcombination group （HR： 20.43 ± 13.52 vs. 15.27 ± 13.71, 18.54 ± 10.07; SBP： 39.26 ± 16.64 vs. 25.80 ± 21.09, 31.50 ± 28.20; DBP： 21.35 ± 12.91 vs. 14.07 ± 10.53, 16.42 ± 13.55, P〈0.05 or P〈0.01 ）. Vr （ml） at 1 hour after beginning of the treatment in combination group was decreased significantly compared with propofol group and midazolam group （ 121.06 ± 96.50 vs. 33.36 ± 28.49, 39.94± 33.24, both/9〈0.01 ）. The drug dosage （mg/kg） in eombination group was decreased significantly compared with propofol group and midazolam group （total dosage of propofol： 25.21 ± 15.33 vs. 90.83 ± 17.42, total dosage of midazolam： 2.37 ± 1.87 vs. 4.02 ± 3.62, both P〈0.01 ）, but there was no significant difference in sedation time among groups. EICU stay days in combination group was shortened significantly compared with propofol group and midazolam group （7.75 ± 5.20 vs. 12.53 ± 8.24, 15.20 ± 8.33, both P〈0.05 ）, but there was no significant difference in mechanical ventilation duration among groups. Conclusion A combination of propofol with midazolam for emergency critically ill patients on mechanical ventilation not only can achieve a good sedative effect, reduce total amount of the drug, but also alleviate the inhibitory effect of propofol on the circulation, improve the symptoms of asynchronous ventilation, and reduce stay time in EICU.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第6期356-359,共4页
Chinese Critical Care Medicine
基金
浙江省医学创新学科建设计划项目（11-CX26）
浙江省“十二五”高校重点学科建设项目（2012-80）
关键词
丙泊酚
咪达唑仑
急危重病
机械通气
Propofol
Midazolam
Critical ill
Mechanical ventilation
