异丙酚和咪唑安定对机械通气患者镇静效果的对比观察.DOCVIP

临床医学论文-异丙酚和咪唑安定对机械通气患者镇静效果的对比观察 　　【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(P0．01)。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(P0．05)，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P0．01。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 　　 　　【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(P0．01).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 respirati