咪达唑仑或丙泊酚联用右美托咪啶对颅脑创伤患者镇静作用的比较  

Comparative analysis of sedative effects mediated by dexmedetomidine in combination with propofol or midazolam in traumatic brain injury patients

作　　者：许涛[1] 杨涛[1] 曹好好[1] 许美霞[1] 张晓霞[1] 毕传华 代小娟[1] 邹卫 

机构地区：[1]华中科技大学同济医学院附属普爱医院重症医学科,湖北武汉430034 [2]武汉医药卫生学会联合办公室,湖北武汉430014

出　　处：《中国医院药学杂志》2015年第4期326-329,共4页Chinese Journal of Hospital Pharmacy

摘　　要：目的：比较右美托咪啶联用丙泊酚或咪达唑仑对急性中度颅脑损伤患者镇静的临床疗效及24 h费用。方法：对75例颅脑外伤患者分别给予丙泊酚或咪达唑仑镇静,同时联合使用右美托咪啶镇静,维持镇静躁动评分（SAS）2-4分为标准,观察24 h镇静效率、生命体征、格拉斯哥昏迷程度评分（GCS）的变化,并比较两组镇静药物的总体费用。结果：右美托咪啶联用丙泊酚或咪达唑仑均能使患者达到预定的镇静镇痛目标评分,2组患者镇静前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）均有明显下降,且丙泊酚组下降幅度更明显（P〈0.05）;而镇静前后的血氧饱和度（SPO2）、动脉血二氧化碳分压（PaCO2）、GCS评分以及中心静脉压（CVP）均无明显差异（P〉0.05）;但联用丙泊酚组总体费用较高（558±218比422±120,P〈0.05）。结论：2组患者均可取得较好的镇静效果,但丙泊酚较咪达唑仑具有更显著的呼吸、循环抑制效应;在镇静镇痛费用方面,丙泊酚组明显高于咪达唑仑组。OBJECTIVE To compare the clinical efficacy and pharmacoeconomic profiles of dexmedetomidine administered in combination with either propofol or midazolam to in patients with acute moderate traumatic brain injury.METHODS 7A total of 75 patients with brain injury were divided into two groups and administered with either propofol or midazolam to achieve sedation.Patients in Bboth groups were also given dexmedetomidine.After drug administration,sedation was achieved within24 hours in all patients.A Sedation-Agitation Scale（SAS）scores between 2-and 4 points wereas maintained as thea standards,and vital signs and Glasgow coma scores（GCS）were monitored for both groups.The total costs of the sedatives of thegiven to e twoach groups wereas also compared and analyzed.RESULTS All patients in each group achieved the expected sedative effect and analgesia scores,and they also showed a decline in mean arterial pressure（MAP）,respiration rate（RR）and heart rate（HR）after sedation.However,the propofol group showed a greater decrease in MAP,RR,and HR after sedation as compared to the midazolam group.In each group,there was no significant difference was observed in pulse oxygen saturation（SPO2）,partial pressure of carbon dioxide in artery（PaCO2）,central venous pressure（CVP）or GCS score before and after sedation.The cost of treatment given toin the propofol group was found to be greater than that ingiven to the midazolam group（558±218 RMBYuan vs.422±120 RMBYua,n,P〈0.05））.CONCLUSION Both groups of patients have achieved the expected sedative effects bywith dexmedetomidine administered in combination with either propofol or midazolam.However,compared tothe effects of midazolam combined with dexmedetomidine,propofol combined with dexmedetomidine demonstrateds a more significantgreater inhibition of respiration and circulation.Additionally,tThe cost of treatment in given to the propofol group was slightly higher than that of midazolam group.

关 键 词：颅脑外伤 镇静 右美托咪啶 丙泊酚 咪达唑仑 

分 类 号：R969.4[医药卫生—药理学]