摘要
目的比较咪达唑仑与丙泊酚复合瑞芬太尼对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者镇静、镇痛的效果。方法选择68例ARDS患者为研究对象,随机分为A组(丙泊酚联合瑞芬太尼)和B组(咪达唑仑联合瑞芬太尼),每组34例。所有患者进入ICU后接受常规重症监护,监测并比较两组心率(heart rate,HR)、平均血压(mean blood pressure,MBP)、呼吸频率(respiratory rate,RR)、血氧饱和度(oxygen saturation,SpO2)、呼气末正压(positive end expiratory pressure,PEEP)、氧合指数(oxygenation index,OI)、镇静及镇痛效果和不良反应发生情况。结果用药后两组患者HR、MBP、RR及PEEP均显著低于用药前(P<0.05);SpO2、OI均显著高于用药前(P<0.05)。A组患者用药后HR、MBP及停药后再入睡发生率显著低于B组(P<0.05);A组患者药物起效时间、停药唤醒时间、达到镇静满意时间和机械通气时间均显著短于B组(P<0.05);B组患者瑞芬太尼用量、低血压发生率显著低于A组患者(P<0.05)。结论咪达唑仑和丙泊酚联合瑞芬太尼治疗急性呼吸窘迫综合征患者均能取得较好的镇静、镇痛效果。丙泊酚镇静效果更好,但对呼吸循环影响较大,咪达唑仑可减少镇痛剂的使用量,价格便宜,临床中应结合患者实际情况选择最佳镇静、镇痛方案。
Objective To compare the effect of sedative and analgesic of midazolam with propofol combined with remifentanil in patients with acute respiratory distress syndrome(ARDS).Methods Sixty eitght cases of patients with ARDS were recruited and divided into group A(propofol combined with remifentanil)and group B(midazolam combined with remifentanil)by random number table,each group 34 cases.After entering into ICU,the patients have been taken heart rate(HR),mean blood pressure(MBP),respiratory rate(RR),oxygen saturation(SpO2),positive end-expiratory pressure(PEEP)and oxygenation index(OI),sedative and analgesic effects and adverse reactions were monitored and compared between the two groups.Results After treatment,the HR,MBP,RR and PEEP in the two groups were significantly lower than that before treatment(P<0.05),and the SpO2 and OI were significantly higher than those before treatment(P<0.05).The HR,MBP and the incidence of re-asleep after drug withdrawal in group A were significantly lower than those in group B after treatment(P<0.05).The onset time,withdrawal awakening time,sedative satisfaction time and mechanical ventilation time of patients of group A was significantly shorter than those of group B after treatment(P<0.05).The dosage of remifentanil and the incidence of hypotension in group B were significantly lower than those in group A(P<0.05).Conclusion Both midazolam and propofol combined with remifentanil in the treatment of acute respiratory distress syndrome patients can achieve good sedative and analgesic effects.The sedative effect of propofol is better,but it has a greater impact on respiratory circulation.Midazolam can be used with lower doses for analgesics,and is cheaper.In clinical practice,the best sedative and analgesic scheme should be selected according to the actual situation of patients.
作者
瞿昌晶
郭旋
朱锋
陈慧丽
汪漩
QU Chang-jing;GUO Xuan;ZHU Feng;CHEN Hui-li;WANG Xuan(Department of Anesthesiology,Yangpu Hospital Affiliated to Tongji University,Shanghai 200090,China)
出处
《世界临床药物》
CAS
2019年第10期707-711,共5页
World Clinical Drug
基金
上海市科学技术委员会基金资助项目(16DZ1911100)
