摘要
目的探讨丙泊酚、咪达唑仑及右美托咪定对机械通气患者血流动力学及氧代谢的影响。方法将60例机械通气患者分为丙泊酚组(P组)、咪达唑仑组(M组)及右美托咪定组(D组),每组各20例。对每组镇静前后及不同组间镇静后血流动力学及氧代谢指标变化进行比较。结果三组患者镇静后心率、平均动脉压、心排量、心指数及氧供均有不同程度下降,中心静脉血氧饱和度(ScvO2)均有不同程度上升,而全身血管阻力指数(SVRI)、全心舒张末期容积指数(GEDVI)仅在D组镇静后有所下降(P均<0.05)。镇静后三组患者的心率、平均动脉压、SVRI、GEDVI、心排量、心指数、氧供及ScvO2比较,差异均有统计学意义(P均<0.05)。进一步两两比较,心率、平均动脉压及ScvO2在M组与D组比较时有统计学意义(P=0.003、0.006、0.000),SVRI水平在D组与P组及M组比较时均有统计学意义(P=0.001、0.015),而GEDVI、心排量、心指数仅在D组与P组比较时有统计学意义(P=0.015、0.011、0.002)。结论三种药物均能达到减少氧耗作用且镇静效果确切,但使用右美托咪定镇静时需注意药物所致心动过缓及低血压的风险,而使用丙泊酚镇静时需注意药物对心功能的抑制。
Objective To investigate the effects of propofol, midazolam and dexmedetomidine on the hemodynamics and oxygen metabolism in mechanical ventilation patients. Methods Sixty mechanical ventilation patients were randomly divided into three groups： propofol group （P group）, midazolam group （M group） and dexmedetomidine group （D group）, 20 cases in each group. The hemodynamics and oxygen metabolism indicators were recorded and compared. Results After sedation, the heart rate, mean arterial pressure, cardiac output, heart index and oxygen delivery all declined in various degrees, the levels of central venous blood oxygen saturation （ScvO2） increased in various degrees in all three groups, and the systemic vascular resistance index （SVRI） and global end-diastolic volume index （GEDVI） levels only decreased in D group （all P 〈 0.05）. The heart rate, mean arterial pressure, SVRI, GEDVI, cardiac output, heart index, oxygen delivery and ScvO2 all showed significant differences among three groups after sedation （all P〈 0.05）. Moreover, significant differences were obvserved in the heart rate,mean arterial pressure, and ScvO2 between M group and D group （P = 0.003, 0.006, 0.000）, the levels of SVRI in the D group as compared with P group and M group （P= 0.001, 0.015）, and the GEDVI, cardiac output, heart index between P group and D group （P=0.015, 0.011, 0.002）. Conclusions The propofol, midazolam and dexmedetomidine are able to reduce oxygen consumption and have solid sedation effects. However, the risks of bradycardia and hypotension by dexmedetomidine and the inhibition of cardiac functions by propofol should be pay attention.
出处
《中华危重症医学杂志（电子版）》
CAS
2013年第6期30-34,共5页
Chinese Journal of Critical Care Medicine:Electronic Edition
关键词
镇静药
通气机
机械
血流动力学
氧代谢
Sedatives
Ventilators, mechanical
Hemodynamics
Oxygen metabolism
