咪达唑仑复合异丙酚镇静对ICU机械通气患者谵妄的影响  

Effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in intensive care unit

作　　者：傅小云[1] 胡杰[1] 苏德[1] 高飞[1] 杨学忠[1] 喻田 

机构地区：[1]遵义医学院附属医院重症医学科,563003 [2]遵义医学院麻醉学系

出　　处：《中华麻醉学杂志》2015年第3期344-346,共3页Chinese Journal of Anesthesiology

基　　金：基金项目：贵州省科学技术基金（黔科合J字[2010]2180号）

摘　　要：目的评价咪达唑仑复合异丙酚镇静对ICU机械通气患者谵妄的影响。方法选择需行镇静镇痛气管插管、呼吸机辅助呼吸的ICU患者522例，年龄28—64岁，体重41～82kg，性别不限，根据治疗期间的镇静方法分为2组：咪达唑仑镇静组（M组，n=240）和咪达唑仑＋异丙酚镇静组（MP组，n=232）。M组和MP组静脉输注咪达唑仑0．03～0．17mg／min镇静，静脉输注舒芬太尼0．07～0．14μg／min镇痛。MP组当循环稳定、压力支持8～10cmH2O、潮气量〉400ml、通气频率〈25次／min、吸入氧浓度〈45％时，改为静脉输注异丙酚0.8～2．0mg／min镇静，镇静时间12～24h。机械通气期间维持Richmond躁动一镇静量表评分-1-12分。记录谵妄的发生情况和持续时间，并根据Richmond躁动一镇静量表评分将其分为兴奋型、抑制型和混合型，记录不同类型谵妄的发生情况和持续时间。结果2组谵妄发生率和持续时间比较差异无统计学意义（P〉0．05）。与M组比较，MP组兴奋型谵妄发生率降低（P〈0．05），抑制型和混合型谵妄的发生率、不同类型谵妄持续时间差异无统计学意义（P〉0．05）。结论 咪达唑仑复合异丙酚可降低ICU机械通气患者兴奋型谵妄的发生，但不能缩短谵妄持续时间。Objective To evaluate the effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in the intensive care unit （ICU）. Methods Five hundred and twenty-two patients who required sedation and analgesia, endotracheal intubation and mechanical ventilation used to assist respiration, aged 28-64 yr, weighing 41-82 kg, were randomized into 2 groups according to the sedation protocols during therapy： sedation with midazolam group （group M, n = 240） and sedation with midazolam ＋ propofol group （group MP, n=232）. In M and MP groups, sedation was induced with midazolam infusion 0.03-0.17 mg/min, and analgesia was induced with sufentanil infusion 0.07-0.14μg/min. In group MP, when hemodynamics was stable, pressure support was 8- 10 cmH2O, tidal volume〉400 ml, RR 〈 25 bpm, and FiO2 〈45%, sedation was induced with propofol infusion 0.8-2.0 mg/min instead, lasting for 12-24 h. Richmond Agitation Sedation Scale score was maintained at -1 to -2 during ventilation. The development and duration of delirium were recorded. Delirium was divided into hyperactive delirium, hypoactive delirium and mixed delirium 3 subtypes, and the development and duration of the 3 subtypes of delirium were also recorded. Results There was no significant difference between the two groups in the incidence and duration of delirium. Compared to group M, the incidence of hyperactive delirium was significantly decreased, and no significant change was found in the incidence of hypoactive delirium and mixed delirium and the duration of the 3 subtypes of delirium in group MP. Conclusion Sedation with midazolam and propofol can decrease the development of hyperactive delirium, but can not shorten the duration of delirium in mechanically ventilated patients in the ICU.

关 键 词：咪达唑仑 二异丙酚 清醒镇静 谵妄 呼吸 人工 

分 类 号：R614[医药卫生—麻醉学]