异丙酚和咪唑安定对机械通气患者镇静效果的对比观察(1)
【摘要】 目的 探讨异丙酚和咪唑安定两种药物在机械通气患者中的镇静效果差异。方法 选择2007年1月至2008年5月ICU收治的320例机械通气患者，分为两组,异丙酚组120例,咪唑安定组200例。 异丙酚组：插管前予静脉注射异丙酚1.00~3.00 mg/kg，插管后行机械通气,用输液泵持续予静脉注射异丙酚0.50~4.00 mg/(kg•h)，镇静持续时间为(25±5.6)h。 咪唑安定组插管前则静脉注射咪唑安定0.06~0.30 mg/kg行镇静诱导，插管后行机械通气,用输液泵持续予静脉注射咪唑安定0.04~0.20 mg/(kg•h)。镇静持续时间为(28.5±6.4)h。结果 药物起效时间异丙酚组为(15±5)s,咪唑安定组为(63.1±10.3)s,两组比较差异有统计学意义(P<0.01)。两组患者均达到Ramsay氏分级标准3~4级之间,异丙酚组所需时间为(20±15)min，咪唑安定组所需时间为(30±16)min。两组患者用药前后血氧饱和度、动脉血氧分压、动脉血二氧化碳分压、呼吸均有明显改善(P<0.05)，组间差异无统计学意义。停药后神志恢复时间：异丙酚组(9.6±6.5)min,咪唑安定组(55±10.7)min,两组比较P<0.01。异丙酚组有5例出现血压下降。结论 异丙酚和咪唑安定用于ICU危重患者的镇静均能取得满意的镇静效果。
【关键词】异丙酚；咪唑安定；机械通气；镇静
Comparison the sedative effect ofPropofol andMidazolan during mechanical ventilation in ICU
LI Xiao-yu,MA Hong-yuan.Department of Intencive Care Unit,The Third People’s Hospital of Chengdu，Sichuan 610031,China
【Abstract】 Objective To study the difference of sedative effects of Propofol and Midazolam on patients with mechanical ventilation.Methods 320 ICUpatients with mechanical ventilation from Jan 2007 to May 2008 were divided into two groups,120 patients were given with Propofol and the other 200 patients with Midazolam.In Propofol group：Propofol(1.00~3.00 mg/kg)was injected intravenously as sedative induction before intubation,administer mechanical ventilation after intubation,followed by continuous injection intravenous 0.50~4.00 mg/(kg•h)using injecting pump.The duration of sedation was(25±5.6)hours.In Midazolam group：Midazolam(0.06~0.30 mg/kg)was injected intravenously as sedative induction before intubation,administer mechanical ventilation after intubation,followed by continuous injection intravenous 0.04~0.20 mg/(kg•h)using injecting pump.The duration of sedation was(28.5±6.4)h.Results The time to take effect of propofol group was(15±5)seconds,compared with(63.1±10.3)seconds in Midazolam group,showing significant difference(P<0.01).Grades 3~4 ramsay classification was reached in patients of both groups.The time needed to reach it was(20±15)min in the Propofol group and(30±15)min in Midazolam group.Performance of blood oxygen saturation,arterial partial pressure of oxygen,arterial carbon dioxide partial pressure and respiration were improved significantly for both group of patients.And there was no remarkable significance in differences between the two groups(P<0.05).Consciousness recovery time after stopping drug：the Propofol group was(9.6±6.5)min and the Midazolam group was(55±10.7)min(P<0.01).5 cases in Propofol group were recorded dropped blood pressue.Conclusion Both Propofol and Midazolam have good sedative effects in ICU patients.
【Key words】Propofol；Midazolam；Mechanical ventilation；Sedation
机械通气是救治各种原因导致的呼吸衰竭患者的重要措施之一，但患者往往不能耐受气管插管，常需足够的镇静甚至镇痛处理，异丙酚和咪唑安定分别为近年来常用于临床的静脉麻醉药和苯二氮卓类药。本研究旨在观察两者在机械通气患者中的镇静效果差异。
1 资料与方法
1.1 一般资料 选择成都市第三人民医院2007年1月至2008年5月 ICU收治的320例机械通气患者，随机分为两组，其中异丙酚组120例，男77例，女43例，年龄45~86岁，平均65.1岁，咪唑安定组200例，男112例，女88例，年龄48~80岁，平均62.8岁。所有患者均行气管插管并接呼吸机辅助呼吸，均予心电图、血压、血氧饱和度和呼吸监测。
1.2 方法 异丙酚组：先静脉注射异丙酚1.00~3.00 mg/kg行镇静诱导，然后改用微量输液泵持续静脉注射异丙酚 0.50~4.00 mg/(kg•h)，镇静持续时间为(25±5.6)h 。咪唑安定组：先静脉注射咪唑安定0.06~0.30 mg/kg行镇静诱导，再用输液泵持续静脉注射咪唑安定0.04~0.20 mg/(kg•h)，镇静持续时间为(28.5±6.4)h。镇静效果根据Ramsay氏分级标准[1]：1级 患者焦虑不安；2级 患者能定向，安静合作；3级 患者入睡，但对语言有反应；4级 患者入睡，对眉间轻弹有快速反应；5级 患者入睡,对眉间轻弹反应迟钝;6级 无反应。所有患者镇静程度控制在3~4级之间。每30 min评估1次。镇静开始前即刻及镇静开始后每1 h记录血压、心率、呼吸和血氧饱和度。, http://www.100md.com(李晓玉 祃红原)
【关键词】异丙酚；咪唑安定；机械通气；镇静
Comparison the sedative effect ofPropofol andMidazolan during mechanical ventilation in ICU
LI Xiao-yu,MA Hong-yuan.Department of Intencive Care Unit,The Third People’s Hospital of Chengdu，Sichuan 610031,China
【Abstract】 Objective To study the difference of sedative effects of Propofol and Midazolam on patients with mechanical ventilation.Methods 320 ICUpatients with mechanical ventilation from Jan 2007 to May 2008 were divided into two groups,120 patients were given with Propofol and the other 200 patients with Midazolam.In Propofol group：Propofol(1.00~3.00 mg/kg)was injected intravenously as sedative induction before intubation,administer mechanical ventilation after intubation,followed by continuous injection intravenous 0.50~4.00 mg/(kg•h)using injecting pump.The duration of sedation was(25±5.6)hours.In Midazolam group：Midazolam(0.06~0.30 mg/kg)was injected intravenously as sedative induction before intubation,administer mechanical ventilation after intubation,followed by continuous injection intravenous 0.04~0.20 mg/(kg•h)using injecting pump.The duration of sedation was(28.5±6.4)h.Results The time to take effect of propofol group was(15±5)seconds,compared with(63.1±10.3)seconds in Midazolam group,showing significant difference(P<0.01).Grades 3~4 ramsay classification was reached in patients of both groups.The time needed to reach it was(20±15)min in the Propofol group and(30±15)min in Midazolam group.Performance of blood oxygen saturation,arterial partial pressure of oxygen,arterial carbon dioxide partial pressure and respiration were improved significantly for both group of patients.And there was no remarkable significance in differences between the two groups(P<0.05).Consciousness recovery time after stopping drug：the Propofol group was(9.6±6.5)min and the Midazolam group was(55±10.7)min(P<0.01).5 cases in Propofol group were recorded dropped blood pressue.Conclusion Both Propofol and Midazolam have good sedative effects in ICU patients.
【Key words】Propofol；Midazolam；Mechanical ventilation；Sedation
机械通气是救治各种原因导致的呼吸衰竭患者的重要措施之一，但患者往往不能耐受气管插管，常需足够的镇静甚至镇痛处理，异丙酚和咪唑安定分别为近年来常用于临床的静脉麻醉药和苯二氮卓类药。本研究旨在观察两者在机械通气患者中的镇静效果差异。
1 资料与方法
1.1 一般资料 选择成都市第三人民医院2007年1月至2008年5月 ICU收治的320例机械通气患者，随机分为两组，其中异丙酚组120例，男77例，女43例，年龄45~86岁，平均65.1岁，咪唑安定组200例，男112例，女88例，年龄48~80岁，平均62.8岁。所有患者均行气管插管并接呼吸机辅助呼吸，均予心电图、血压、血氧饱和度和呼吸监测。
1.2 方法 异丙酚组：先静脉注射异丙酚1.00~3.00 mg/kg行镇静诱导，然后改用微量输液泵持续静脉注射异丙酚 0.50~4.00 mg/(kg•h)，镇静持续时间为(25±5.6)h 。咪唑安定组：先静脉注射咪唑安定0.06~0.30 mg/kg行镇静诱导，再用输液泵持续静脉注射咪唑安定0.04~0.20 mg/(kg•h)，镇静持续时间为(28.5±6.4)h。镇静效果根据Ramsay氏分级标准[1]：1级 患者焦虑不安；2级 患者能定向，安静合作；3级 患者入睡，但对语言有反应；4级 患者入睡，对眉间轻弹有快速反应；5级 患者入睡,对眉间轻弹反应迟钝;6级 无反应。所有患者镇静程度控制在3~4级之间。每30 min评估1次。镇静开始前即刻及镇静开始后每1 h记录血压、心率、呼吸和血氧饱和度。, http://www.100md.com(李晓玉 祃红原)