咪达唑仑联合右美托咪定对ICU术后机械通气患者镇静效果的影响

摘要

目的：探究咪达唑仑联合右美托咪定对ICU术后机械通气患者镇静效果的影响。方法将2013年6月至2015年6月本院治疗的160例术后转入的ICU机械通气患者随机分为观察组与对照组。观察组患者先微量静脉注射右美托咪定负荷剂量1μg/kg持续10分钟后，再静脉泵入咪达唑仑0.08 mg/（kg•h）、右美托咪定0.2μg/（kg•h）、48 ml 0.7%生理盐水维持；对照组患者给予0.06 mg/kg咪达唑仑负荷剂量，然后静脉泵入咪达唑仑0.08～0.10 mg/（kg•h）及等量生理盐水维持。比较两组患者苏醒时间、拔管时间、镇静效果及镇静期间不良反应发生情况。结果两组患者镇静后30分钟心率（HR）、平均动脉压（MAP）、舒张压（DBP）及脑电双频指数（BIS）均明显降低（P＜0.05），脉搏血氧饱和度（SpO2）及收缩压（SBP）无明显变化（P＞0.05）。镇静后30分钟观察组患者HR、MAP均高于对照组（P＜0.05）。观察组患者结束镇静后呼吸恢复时间、睁眼时间及拔管时间均短于对照组（P＜0.05或P＜0.01）。观察组患者总不良反应发生率为8.75%，对照组为36.25%，比较差异具有显著性（P＜0.01）。结论咪达唑仑联合右美托咪定对患者的镇静过程中循环系统影响小，可使患者的呼吸稳定，减少机械通气时间，不良反应发生率低。%ObjectiveTo explore the effect of midazolam combined with dexmedetomidine on sedation in mechanically ventilated patients after ICU surgery.Method160 cases of mechanically ventilated patients after ICU surgery from June 2013 to June 2015 were randomly divided into observation group and control group. In observation group, loading dose of 1 μg/kg dexmedetomidine was intravenously injected and lasted 10 minutes. Then midazolam 0.08 mg/(kg•h) and dexmedetomidine 0.2 μg/(kg•h) was pumped into vein, with 48 ml 0.7% normal saline to maintain. In control group, patients were given 0.06 mg/kg midazolam and then the midazolam 0.08~0.10 mg / (kg•h) and normal saline to maintain with intravenous pump. The recovery time, extubation time, sedation effect and adverse reaction of two groups were compared.ResultAfter sedation 30 minutes, the heart rate (HR), mean arterial pressure (MAP), diastolic blood pressure (DBP) and bispectral index (BIS) were signiifcantly decreased in both groups (P<0.05), and with no signiifcant changes in SpO2 and SBP (P>0.05). The HR and MAP of observation group were signiifcantly higher than control group 30 minutes after sedation (P<0.05). In observation group, breathing recovery time after sedation, eye opening time and extubation time were less than control group (P<0.05 orP<0.01). The incidence of adverse reactions of observation group was 8.75%, and control group was 36.25%, the difference was signiifcant (P<0.01).ConclusionThe circular effect of midazolam combined with dexmedetomidine in sedation of patients is small, which could also make breathing stable, and reduce the duration of mechanical ventilation and adverse reaction rate.