摘要
目的探讨丙泊酚与咪达唑仑-芬太尼合剂应用在机械通气的老年患者中的镇静效果及不良反应的差异。方法选自2008年5月~2009年12月我科ICU收治的需要呼吸机辅助通气的老年患者38例,年龄60~92岁,ApacheⅡ评分16~32,随机分为P组(丙泊酚组,17例)及M-F组(咪达唑仑-芬太尼组,21例)。给予机械通气后患者均出现不同程度的人机对抗,P组静脉推注丙泊酚2.0mg/kg,之后根据不同镇静程度用药量为1.0~3.0mg·kg-1·h-1静脉泵入持续镇静;M-F组患者静脉推注咪达唑仑3.0mg及芬太尼0.1mg,之后以咪达唑仑100μg·kg-1·h-1、芬太尼2μg·kg-1·h-1同时静脉泵入镇静。观察两组用药后达到Ramsay3~4级所需的时间及停药后苏醒时间并记录患者用药前及达到满意镇静效果后患者的血压、心率、血氧饱和度以及出现明显心率、血压下降的例数。结果 P组达到Ramsay3~4级所需的时间为(23.3±7.7)min,M-F组达到Ramsay3~4级所需的时间为(54.3±19.8)min,两组比较差异有统计学意义(P<0.05)。两组比较患者用药后血氧饱和度、心率、血压均较用药前有明显改善(P<0.05)。停药后苏醒时间:P组(16.1±5.1)min,M-F组(34.9±13.0)min,两组比较,有统计学差异(P<0.01)。M-F组中有4例出现给药后5分钟内血压短暂下降超过25%,3例心率下降超过25%;P组中有1例给药后5分钟内血压短暂下降超过25%。结论丙泊酚与咪达唑仑-芬太尼均对机械通气的患者是有效的镇静剂,但丙泊酚起效快、苏醒时间短、不良反应少,对老年患者更为安全。
Objective To compare the sedative efficacy and side effect between propofol and midazolam-fentanyl on the elderly patients with mechanical ventilation. Methods Thirty-eight elderly patients with mechanical ventilation hospitalized in ICU department were divided into two groups. 17 cases in group P were given continuous intravenous injection of propofol in 2mg·kg-1·h-1 after a single intravenous bolus injection at dose of 1.0~3.0mg/kg.21 cases in group M-F were given continuous intravenous injection of midazolam in 100μg·kg-1·h-1 and fentanyl in 2μg·kg-1·h-1 after a single midazolam intravenous bolus injection. The sedative efficacy and changes of respiratory, circulate parameter before and after medication were observed. Results The time to take effect of propofol group was (23.3±7.7)min compaired with (54.3±19.8)min in midazolam and fentanyl group,showing significant differences (P<0.05). Consciousness recovery time after stopping drug: the propofol group was (16.1± 5.1)min and the midazolam-Fentanyl group was (34.9±13.0)min(P<0.01).4 cases in M-F group were recorded droped blood pressure above 25% in 5 min,3 cases in M-F group were recorded droped heart rate above 25% in 5 min, 1 case in P group were recorded droped blood pressure above 25% in 5 min. Conclusion For patients with mechanical ventilation, propofol and midazolam-fentanyl are both effective. But Propofol is a relatively ideal sedative to the elderly patients with less side effect.
出处
《中国现代医药杂志》
2010年第7期28-30,共3页
Modern Medicine Journal of China
关键词
机械通气
镇静
丙泊酚
咪达唑仑
芬太尼
Mechanical ventilation Sedation Propofol Midazolam Fentanyl
