咪达唑仑联合舒芬太尼在呼吸衰竭机械通气患者中的应用  

Application of midazolam combined with sufentanil in patients of respiratory failure during mechanical ventilation

作　　者：黎祖荣[1] 聂静[1] 董静[1] 王懿春[1] 陈飞[1] 戴晓薇[1] 

机构地区：[1]湖南省肿瘤医院重症医学科,湖南长沙410013

出　　处：《现代医药卫生》2013年第6期836-837,共2页Journal of Modern Medicine & Health

摘　　要：目的观察重症监护病房(ICU)呼吸衰竭患者采用咪达唑仑联合舒芬太尼镇静、镇痛对呼吸循环以及机械通气效果的影响。方法选择ICU内机械通气治疗患者50例,所有患者均建立人工气道,进行有创机械通气,当出现明显人机对抗表现时给予镇静、镇痛治疗,先给予舒芬太尼负荷量0.1～0.4μg/kg、咪达唑仑负荷量0.05～0.10 mg/kg,而后咪达唑仑50 mg、舒芬太尼50μg加生理盐水配成50 mL,用微量注射泵持续静脉泵注,根据Ramsay评分监测镇静效果、调节剂量,使患者Ramsay分级处于3～5级。结果 50例患者镇静效果满意,Ramsay评分与镇静前比较,差异有统计学意义(P<0.01);镇静后,患者呼吸频率、心率、平均动脉压明显下降(P<0.01),氧合指数、动脉血氧分压(PaO2)、脉搏血氧饱和度(SpO2)与镇静前比较明显升高(P<0.01)。结论咪达唑仑联合舒芬太尼对机械通气患者有良好的镇静、镇痛效果,通过镇静、镇痛可以提高患者对机械通气的耐受性,从而提高机械通气治疗的效果。Objective To observe the influence of midazolam combined with sufentanil for sedation and analgesia on respiration,circulation and mechanical ventilation effects in the patients with respiratory failure in ICU.Mathods 65 patients with mechanical ventilation in ICU were selected.All patients were established artificial airway for invasive mechanical ventilation.When the performance of man-machine confrontation appeared,the analgesic and sedation treatment was given,at first with the loading dose of sufentanil 0.1-0.4 μg/kg and midazolam 0.05-0.10 mg/kg by intravenous injection,nextly 50 mL mixed solution of midazolam 50 mg and sufentanil 50 μg adding normal saline was continuously infused by micro-injection pump.According to the Ramsay score,the sedative level was monitored and the dose was adjusted to Ramsay sedation level Ⅲ-Ⅴ.Results The sedative effects in 50 patients were satisfactory.The Ramsay scores after sedation showed statistical difference compared with before sedation（P0.01）.After the sedation,heart rate,breath rate and mean blood artery pressure were decreased obviously（P0.01）,while the oxygenation index,PaO2 and SpO2 were significantly increase compared with before sedation（P0.01）.Conclusion Midazolam combined with sufentanil has good sedative and analgesic effect on postoperative patients during mechanical ventilation,can improve the patient′s tolerance to mechanical ventilation through sedation and analgesia,thus enhance the effect of mechanical ventilation.

关 键 词：呼吸 人工 呼吸功能不全 治疗 咪达唑仑 治疗应用 舒芬太尼 治疗应用 

分 类 号：R472.9[医药卫生—护理学]