右美托咪定联合咪达唑仑用于ICU患者镇静的效果  

Dexmedetomidine Combined with Midazolam for Sedation in ICU Patients

作　　者：陶霞[1] 聂庆英 章宏斌 熊申生[1] 

机构地区：[1]南昌大学第二附属医院急诊科,南昌330006 [2]武宁县人民医院麻醉科,江西武宁332300 [3]婺源县人民医院麻醉科,江西婺源333200

出　　处：《南昌大学学报（医学版）》2016年第6期46-49,共4页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生厅科技计划项目(20133069)

摘　　要：目的探讨右美托咪定联合咪达唑仑用于ICU行机械通气患者的镇静效果及安全性。方法选择ICU行呼吸机辅助通气患者90例,按随机数字表法分为3组,每组30例。A组、B组、C组分别予咪达唑仑、右美托咪定、右美托咪定联合咪达唑仑镇静。3组均予芬太尼持续静脉泵入镇痛。观察各组患者低血压、心动过缓、谵妄、呼吸抑制等不良反应发生情况,并记录其芬太尼及咪达唑仑用量、停药后唤醒时间。结果 3组均能达到镇静及镇痛目标评分状态。与A组比较:C组芬太尼及咪达唑仑用量更少(P<0.01),谵妄和呼吸抑制发生率更低(P=0.012,P=0.049),停药后唤醒时间更短(P<0.01),低血压和心动过缓发生率显差异无统计学意义(P=0.754,P=0.290)。与B组比较:C组芬太尼用量、心动过缓、瞻妄、呼吸抑制发生率差异无统计学意义(P=0.386,P=0.445,P=0.639,P=0.639),低血压发生率更低(P=0.031),停药后唤醒时间更长(P<0.01)。结论右美托咪定联合咪达唑仑用于ICU机械通气患者镇静效果确切,停药后较易唤醒,谵妄发生率低,呼吸抑制、低血压及心动过缓发生率较低,可减少咪达唑仑及芬太尼用量,是一种较为理想的ICU镇静方式。Objective To investigate the efficacy and safety of dexmedetomidine combined with midazolam for sedation in ICU patients undergoing mechanical ventilation.Methods Ninety ICU patients undergoing mechanical ventilation were randomly given midazolam（group A,n=30）,dexmedetomidine（group B,n=30）,or their combination（group C,n=30）for sedation.In addition,all patients received continuous intravenous infusion of fentanyl for analgesia.The hypotension,bradycardia,delirium,respiratory depression and other adverse reactions were observed,and the dosages of fentanyl and midazolam and wake-up time after drug withdrawal were recorded.Results Sedative and analgesic targets were obtained in all the three groups.Compared with group A,dosages of fentanyl and midazolam and incidences of respiratory depression and delirium were decreased and wake-up time after drug withdrawal was shortened in group C（P〈0.01 or P〈0.05）.There were no significant differences in incidences of hypotension and bradycardia between group A and group C（P〉0.05）.Compared with group B,the incidence of hypotension and wake-up time was prolonged in group C（P〈0.01 or P〈0.05）.No significant differences were found in the dosage of fentanyl and incidences of bradycardia,delirium,repiratory depression between group B and group C（all P〉0.05）.Conclusion As an effective and ideal sedative method,the combination dexmedetomidine and midazolam can shorten the time to wake-up,reduce incidences of delirium,respiratory depression,hypotension and bradycardia,and decrease dosages of fentanyl and midazolam in ICU patients.

关 键 词：右美托咪定 咪达唑仑 镇静 不良反应 机械通气 

分 类 号：R614[医药卫生—麻醉学]