不同镇静方法对呼吸衰竭机械通气患者儿茶酚胺及血流动力学的影响  

Effects of different sedative methods on catecholamine and hemodynamics in mechanical ventilation patients with respiratory failure

作　　者：徐陶[1] 甘辞海[1] 王晓斌[2] 

机构地区：[1]泸州医学院附属医院ICU,四川泸州646000 [2]泸州医学院附属医院麻醉科,四川泸州646000

出　　处：《现代医药卫生》2015年第15期2265-2267,共3页Journal of Modern Medicine & Health

摘　　要：目的观察2种镇静方法对呼吸衰竭机械通气患者血儿茶酚胺水平及血流动力学的影响。方法选取2014年1-12月需行气管插管机械通气的呼吸衰竭患者54例,分为对照组（C组）、丙泊酚联合芬太尼组（P＋F组）、咪达唑仑联合芬太尼组（M＋F组）,每组18例。分别在插管前、气管插管（镇静）后30 min、插管后3 h检测血儿茶酚胺水平,同时观察对应时间点的心率、血压。结果与插管前比较,C组患者气管插管后30 min的血儿茶酚胺水平、心率及血压显著升高,P＋F组与M＋F组插管后30 min、3 h血儿茶酚胺水平、心率及血压显著降低,差异均有统计学意义（P〈0.05）。与C组插管后30 min比较,P＋F组与M＋F组血儿茶酚胺水平、心率及血压明显降低,差异均有统计学意义（P〈0.05）;与M＋F组插管后30 min、3 h比较,P＋F组相应时间点的血儿茶酚胺水平和心率无较大变化,差异均无统计学意义（P〉0.05）,但血压显著降低,差异有统计学意义（P〈0.05）。结论气管插管机械通气能引起患者血儿茶酚胺水平明显上升,镇静治疗能有效降低气管插管机械通气患者血儿茶酚胺水平,丙泊酚联合芬太尼与咪达唑仑联合芬太尼镇静均能有效减轻患者应激反应,但咪达唑仑联合芬太尼镇静对患者血压影响较小。Objective To observe the effect of two kinds of sedative method on the plasma catecholamine level and hemodynamics in respiratory failure patients with mechanic ventilation. Methods 54 respiratory failure patients needing tracheal intubation and mechanical ventilation in our hospital from January to December 2014 were selected and randomly divided into the control group（C）,propofol＋ fentanyl group（group P＋F） and midazolam＋fentanyl group（group M＋F）,18 cases in each group. The plasma catecholamine content was detected before tracheal intubation,at 30 min,3 h after tracheal intubation,meanwhile HR and BP at the corresponding time points were measured. Results Compared with pre-tracheal intubation,plasma catecholamine concentrations,HR and BP at 30 min after tracheal intubation in the group C were significantly increased compared with before tracheal intubation（P〈0.05）;plasma catecholamine concentrations,HR and BP at 30 min,3 h after tracheal intubation in the group P＋F and M＋F were significantly decreased compared with before tracheal intubation,the differences were statistically significant（P〈0.05）. Furthermore,plasma catecholamine concentrations,HR and BP at 30 min after tracheal intubation in the group P＋F and M＋F were significantly decreased compared with the group C,the differences were statistically significant（P〈0.05）;however,there were no statistically significant differences in plasma catecholamine concentrations and HR at 30 min,3 h after tra cheal intubation between the group P＋F and M＋F（P〉0.05）,but BP was significantly decreased with statistical difference（P〈0.05）.Conclusion Tracheal intubation and mechanical ventilation can enhance the level of plasma catecholamine,the sedation therapy can effectively reduce the blood catecholamine concentration in the patients with tracheal intubation and mechanical ventila-tion. Propofol＋fentanyl and midazolam＋fentanyl sedation can effectively alleviate the stress response of patients,but the sedative t

关 键 词：呼吸功能不全 呼吸 人工 儿茶酚胺类 血流动力学 镇静 

分 类 号：R472.9[医药卫生—护理学]