摘要
目的：探讨布托啡诺与咪达唑仑联用在危重病患者机械通气中的镇静镇痛效果。方法选择南京医科大学附属淮安第一人民医院2012年1月至2013年12月入住重症医学科（ICU）接受机械通气并镇静镇痛治疗的患者58例，根据镇静剂种类不同分为单用咪达唑仑组（30例）和布托啡诺联合咪达唑仑组（联用布托啡诺组，28例）。单用组按常规镇静方法首先静脉注射（静注）咪达唑仑0.05-0.10 mg/kg进行镇静诱导，随后用微量注射泵（微泵）持续泵入0.05-0.15 mg·kg^-1·h^-1；联用组先静注布托啡诺10μg/kg负荷剂量，随后用微泵持续泵入布托啡诺10-20μg·kg^-1·h^-1＋咪达唑仑0.05-0.15 mg·kg^-1·h^-1。采用Ramsay镇静分级，从镇静开始后每1-2h评估1次，将两组患者的镇静深度维持在理想的2-4级。观察各组患者用药前后平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）的变化，并记录镇静剂治疗情况。用视觉模拟评分（VAS）评估镇痛情况。结果单用组与联用组患者用药前MAP、HR、SpO2比较差异无统计学意义〔MAP（mmHg，1 mmHg＝0.133 kPa）：121.3±6.2比118.6±8.7，HR（次/min）：129.5±14.1比125.5±16.3，SpO2：0.744±0.112比0.756±0.131，均P＞0.05〕；用药后两组各指标均较用药前有明显改善，差异均有统计学意义〔单用组MAP （mmHg）：88.7±6.5比121.3±6.2，HR（次/min）：85.3±13.4比129.5±14.1，SpO2：0.937±0.056比0.744±0.112；联用组MAP（mmHg）：82.6±7.3比118.6±8.7，HR（次/min）：89.6±14.7比125.5±16.3，SpO2：0.943±0.078比0.756±0.131；均P＜0.05〕，且联用组改善的程度好于单用组。联用组药物起效时间和停药后清醒时间均较单用组明显缩短（min：33.6±6.2比73.3±12.2，71.8±19.3比103.5±30.1，均P＜0.05），且不良反应发生率明显低于单用组（0比13.3%，P＜0.05）。联用组VAS评分明显低于单用组（分：8.4±1.2比2.4±0.8，P＜0.05）。结论布托啡诺联合咪达唑仑用于危重病机械通气患者有着良好的镇静镇痛效果，能提高机械通气患者的耐受性，减少药物不良反应发生率。
Objective To study the sedative and analgesic effects of butorphanol combined with midazolam on critically ill patients treated by mechanical ventilation. Methods Fifty-eight patients who received mechanical ventilation, sedation and analgesia in intensive care unit （ICU） of Affiliated Huaian No.1 Hospital of Nanjing Medical University from January 2012 to December 2013 were enrolled. The patients were divided into a single midazolam group （30 cases） and a combination of butorphanol and midazolam group （combination with butorphanol group, 28 cases） according to the difference in types of sedative. The sedation for patients in the single midazolam group was induced firstly by intravenous injection of 0.05-0.10 mg/kg midazolam and followed by continuous infusion of the same drug 0.05 - 0.15 mg·kg^-1·h^-1 with a micro injection pump. The patients in the combination with butorphanol group were given a loading dose of butorphanol 10μg/kg and followed by continuous infusion of 10-20μg·kg-1·h-1 butorphanol combined with 0.05 - 0.15 mg·kg^-1·h^-1 midazolam by a micro pump. The Ramsay anesthesia score and visual analogue scale （VAS） were used to evaluate the sedative and analgesic effects. According to the Ramsay score, the sedation depths of patients in the two groups were maintained at 2-4 grades, and reassessed every 1-2 hours. The mean arterial pressure （MAP）, heart rate （HR） and pulse blood oxygen saturation （SpO2） were observed before and after the drug administration in two groups. Results There were no statistically significant differences in MAP, HR and SpO2 between single midazolam group and combination with butorphanol group before treatment [MAP （mmHg, 1 mmHg=0.133 kPa）： 121.3±6.2 vs. 118.6±8.7, HR （bpm）：129.5±14.1 vs. 125.5±16.3, SpO2：0.744±0.112 vs. 0.756±0.131, all P〉0.05]. Compared with those before treatment, after treatment, the above indexes in two groups were significantly improved, the differences being statistically significant [single midazolam group：MAP （mmHg） 88.7±6.5 vs. 121.3±6.2, HR （bpm） 85.3±13.4 vs. 129.5±14.1, SpO2 0.937±0.056 vs. 0.744±0.112; combination with butorphanol group： MAP （mmHg） 82.6±7.3 vs. 118.6±8.7, HR （bpm） 89.6±14.7 vs. 125.5±16.3, SpO2 0.943±0.078 vs. 0.756±0.131, all P 〈 0.05], and the degree of improvement of the combination with butorphanol group was better than that of the single midazolam group. The initial acting time of drugs and the time awakening from anesthesia in the combination with butorphanol group were shorter significantly than those in the single midazolam group （minutes： 33.6±6.2 vs. 73.3±12.2, 71.8±19.3 vs. 103.5±30.1, both P 〈 0.05）, and the incidence of adverse reaction was lower obviously than that in the single midazolam group （0 vs.13.3%, P 〈 0.05）. Furthermore, the score of VAS in the combination with butorphanol group was lower significantly than that in single midazolam group （8.4±1.2 vs. 2.4±0.8, P 〈 0.05）. Conclusions Butorphanol combined with midazolam for treatment of critically ill patients with mechanical ventilation is a very effective sedative method, which may improve the degree of patients＆#39; tolerance towards the measure and reduce the incidence of adverse reactions.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2015年第2期157-159,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
国家自然科学基金资助项目（81400807）
关键词
布托啡诺
咪达唑仑
危重病
机械通气
Butorphanol
Midazolam
Critically ill
Mechanical ventilation
