咪唑安定降低重症加强治疗病房清醒患者在邻床心肺复苏时心理应激的研究  

Midazolam attenuates mental stress in conscious patients during cardiopulmonary resuscitation performed next bed in intensive care unit

作　　者：李秦[1] 苏瑾文[1] 刘京涛[1] 王宇[1] 陆翠玲[1] 马朋林[1] 

机构地区：[1]解放军总医院第二附属医院ICU,北京100091

出　　处：《中国危重病急救医学》2008年第4期193-196,共4页Chinese Critical Care Medicine

基　　金：国家卫生部指令性项目课题（WKJ2003-2-0027）

摘　　要：目的探讨在重症加强治疗病房（ICU）进行心肺复苏（CPR）时，邻床（或隔床）清醒危重患者机体应激程度、循环生理改变以及可能的有效干预措施。方法连续选择我院综合ICU清醒危重患者87例，随机分为3组：对照组给予生理盐水；心理干预组由专职护士对其进行心理护理；镇静治疗组在心理护理基础上给予小剂量咪唑安定（0．1mg／kg）静脉注射。前40例于邻床患者开始实施CPR（0min）、10min、4h和24h取静脉血测定血浆去甲肾上腺素（NE）、肾上腺素（Adr）、皮质醇（Col）和血糖浓度。所有患者在实施CPR前30min，CPR后10min、4h和24h记录上肢动脉收缩压（SBP）、平均动脉压（MAP）、心率（HR）和心律变化。结果对照组13例患者在CPR后10min血浆NE、Adr及Col浓度显著升高，并持续4h以上（PG0．05或PG0．01）。心理干预组13例患者上述应激激素变化趋势与对照组基本一致，然而，仅Col升高出现显著差异（PG0．05或PG0．01）。镇静治疗组14例患者上述应激激素于CPR后10min及4h无显著变化，但CPR后24h降低至CPR开始时水平以下（尸均G0．01）。前两组患者血糖升高超过24h，CPR后10minHR显著加快，SPB显著上升，并且心律失常发生率高（84．6％，22／26；54．5％，18／33），而镇静治疗组患者血糖以及循环保持相对稳定，心律失常发生率（21．4％，6／28）较前两组明显降低（P均〈0．01）。结论ICU进行CPR时，邻床清醒危重患者体内应激程度将显著升高，并可能导致严重循环生理改变。单纯给予心理护理措施并不能有效减轻此不良反应，而小剂量咪唑安定是控制此不良反应的有效措施。Objective To evaluate the mental stress level and alterations in circulatory physiology in conscious patients during cardiopulmonary resuscitation （CPR） performed next bed in intensive care unit （ICU）, and to investigate the possible effective interventions. Methods Eighty-seven conscious patients, selected consecutively from June 2003 to September 2006, were randomly allocated into control group （received normal saline）, psychological nursing group （received psychological nursing intervention） or sedation group （received midazolam 0.1 mg/kg intravenous injection based on psychological nursing intervention） when CPR was performed in our ICU. Plasma concentrations of norepinephrine, epinephrine, cortisone and glucose were analyzed at the time points of beginning of CPR, 10 minutes, 4 and 24 hours after CPR in the first 40 patients. Heart rate （HR）, systolic blood pressure （SBP）, mean arterial pressure （MAP） and arrhythmia within 24 hours after CPR were recorded in all patients. Results Plasma levels of norepinephrine, epinephrine and cortisone were significantly increased at 10 minutes after CPR and persisted for 4 hours in 13 patients of the control group （P〈0.05 or P〈0.01）. Though with the similar tendency, significant increase of cortisone level was observed in 13 patients who had received psychological nursing intervention （P〈0. 05 or P〈0.01）. The analyzed stress hormones showed little variation in 14 patients who were given midazolam at 10 minutes and 4 hours after CPR. Notably, 24 hours after CPR, they were decreased below the levels which were observed at the beginning of CPR （all P〈0.01）. Blood glucose levels were markedly higher in both control and psychological nursing groups than the level in sedation group within 24 hours. HR was accelerated 10 minutes after CPR,SBP was significantly increased, the incidence rate of arrhythmia was high （84.6%, 22/26; 54.5%, 18/33） in the non-sedation groups. Circulatory physiological alterations were least marke

关 键 词：心肺复苏 心理应激 清醒危重患者 

分 类 号：R459.7[医药卫生—急诊医学] R395[医药卫生—治疗学]