摘要
目的:比较腹部大型手术后需延长机械通气6h以上的患者,分别应用轻度镇静与深度镇静对发生精神障碍事件的影响。方法:选择60～80岁、全身麻醉、腹部大型择期手术后需延长机械通气6h以上患者142例,均持续给予丙泊酚镇静,随机进入轻度镇静组(Ramsay评分2～3分,n=76)、深度镇静组(Ramsay评分4～5分,n=66),待符合脱机条件后停用丙泊酚,经过脱机试验后拔除气管插管。结果:两组Ramsay评分分别为2.7、4.8(P<0.05),两组拔管时间、意外拔管人数、不舒适感均无显著差异;对机械通气过程中的正确记忆比例轻度镇静组明显高于深度静组(78%vs45%,P<0.05),轻度镇静组精神障碍事件(幻觉、噩梦、被害妄想、谵妄)的总发生率相对较低,但无统计学意义(8%vs25%,P>0.05)。结论:对于全身麻醉的腹部择期手术后需延长机械通气患者,给予轻度镇静,其正确记忆比例明显高于深度镇静,精神障碍事件发生率有下降的趋势。
Objective： To investigate whether the prevalence of mental dysfunction is related to the depth of sedation in the patients with prolonged mechanical ventilation over 6 hours after a major abdominal operation. Methods： Patients, 60-80 yrs undergone general anesthesia and a selective major abdominal operation in need of prolonged mechanical ventilation over 6 hours, were randomly assigned to receive either a light （Ramsay scale 2-3, n=76） or a heavy （Ramsay scale 4-5, n=66） sedation with continuous i.v. infusion of propofol. When the patient recovered to have the ability to breathe normally without ventilator support, propofol will be stopped and the weaning ventilator test will be followed. If the patient passed the test, the tracheal tube would be extubated. Results： The median Ramsay Scales of the two groups were respectively 2.7 and 4.8 （P〈0.05）. The duration of tracheal tube maintaining, the incidence of unplanned extubation, uncomfortable feeling were not significantly different. The patients with a light sedation have more factual memory to the events during mechanical ventilation （78% vs 45%, P〈0.05） with a significant difference and lower prevalence of mental dysfunction （hallucination, nightmare, delusion of persecution, delirium） whereas the difference was not statistically significant （8% vs 25%, P〉0.05）. Conclusions： The investigation shows that a light sedation in the patients with prolonged mechanical ventilation after a major abdominal operation keeps more factual memory and possibly leads to a downtrend to prevalence of mental dysfunction.
出处
《药学与临床研究》
2010年第5期452-454,共3页
Pharmaceutical and Clinical Research
