咪达唑仑联合芬太尼对重症机械通气患者镇静效果的研究  

Research of the sedative effects of midazolam combined with fentanyI on intensived ventilated medical patients

作　　者：喻秋平[1] 赵斌 万于华[3] 万力[3] 喻本桐[3] 

机构地区：[1]九江学院附属医院ICU,九江332000 [2]九江庐山区医院内科,九江332000 [3]南昌大学第一附属医院心胸外科,南昌330006

出　　处：《江西医药》2009年第6期535-537,共3页Jiangxi Medical Journal

基　　金：九江市科技局科技支撑项目课题(20081225)

摘　　要：目的探讨咪达唑仑联合应用芬太尼对重症机械通气患者镇静效果的影响。方法将40例使用机械通气的重症患者,随机分为咪达唑仑组(对照组,n=20)和咪达唑仑加芬太尼组(实验组,n=20),记录镇静前2组呼吸循环指标。镇静开始前2组均给予咪达唑仑0.05mg/kg静注,直至患者镇静达Ramsay3～4级(采用Ramsay镇静评分),对照组给予咪达唑仑(咪达唑仑50mg+生理盐水至50ml),以0.1mg/kg/h微量注射泵持续泵入;实验组选用咪达唑仑和芬太尼(咪达唑仑50mg+芬太尼0.5mg+生理盐水至50ml),以0.1ml/kgh微量注射泵持续泵入,观察2组患者镇静1、6、12、24h呼吸频率、脉搏、平均血压、末梢血氧饱和度、氧合指数及镇静评分。结果镇静后2组呼吸频率、血氧饱和度、氧合指数均较镇静前明显改善(P<0.01);镇静后实验组各时点脉搏均低于对照组(P<0.05),RS评分均高于对照组(P<0.05),各组镇静后平均血压、脉搏、RS评分均较镇静前明显改善(P<0.01)。结论对重症机械通气的患者,咪达唑仑联合应用芬太尼能显著提高患者的镇静效果,增加人机顺应性。Objective To study sedative effect of midazolam combined with fentanyI on intensived ventilated patients. Methods 40 cases of ventilated medical were randomly divided into midazolam group （n=20） and midazolam combined with fentanyI group（n= 20）.Recorded the index of breath and circunlation before Sedation .before Sedation,the two groups were given intravenous midazolam 0.05mg/kg until sedation of patients Ramsay3 - 4 level （the use of Ramsay sedation score）,the control group were given midazolam （midazolam 50rag ＋ 0.9%NaCl to 50ml）, to 0.1mg/kg. h continuous infusion pump microinjection into;the experimental group selected midazolam and fentanyl （fentanyl 50rag ＋ midazolam 0.5mg ＋ 0.9%NaC1 to 50ml）,to continue to 0.1ml/kg/h microinjection pump observed two groups of patients with sedation 1,6,12,24 h respiratory rate, pulse, mean blood pressure, peripheral oxygen saturation, oxygenation index and the sedation score.Results After sedation two groups respiratory rate, oxygen saturation, oxygenation index were significantly improved compared with before sedation （P〈0.01）; after sedation each time point the pulse of the experimental group were lower than of the control group （P〈0.05）, RS score were high in the control group （P〈0.05）, after sedation in each group the average blood pressure, pulse, RS score were significantly improved pre-sedation （P〈0.01）.Conclusion On ventilated medical patients, midazolam combined with fentanyI improves the sedative effect of patients and increase in man-machine compliance.

关 键 词：咪达唑仑 芬太尼 机械通气 镇静 

分 类 号：R614.1[医药卫生—麻醉学]