咪达唑仑复合丙泊酚对ICU机械通气患者拔除气管插管后谵妄发生情况的临床分析  

Clinical analysis of midazolam combined with propofol for delirium in ICU mechanical ventilation patients after trachea cannula extubation

作　　者：龙贻文[1] 周文君[1] 俞琮轶 

机构地区：[1]上海市交通大学医学院附属瑞金医院卢湾分院,200020

出　　处：《中国实用医药》2016年第33期105-107,共3页China Practical Medicine

摘　　要：目的探讨咪达唑仑、咪达唑仑复合丙泊酚治疗对重症监护病房(ICU)患者拔除气管插管后谵妄发生情况。方法 127例ICU接受机械通气同时需要镇静治疗的患者,根据镇静剂使用方式分为咪达唑仑组(M组,68例)及咪达唑仑复合丙泊酚过渡组(MP组,59例),两组咪达唑仑用量相同[先静脉注射2~3 mg,继之以0.05 mg/(kg·h)]静脉推泵维持。当患者血流动力学平稳,呼吸机参数模式调整为CPAP/PSV模式,压力支持8~10 cm H_2O(1 cm H_2O=0.098 kPa)、潮气量>400 ml、通气频率<25次/min、吸氧浓度<45%,自主呼吸良好时,M组停用咪达唑仑静脉推泵后拔管,MP组准备拔管前2 h停用咪达唑仑,改为丙泊酚[0.5~4.0 mg/(kg·h)]镇静,镇静后维持时间2 h,停用镇静药物(期间实行唤醒计划),满足撤机条件后拔除气管插管,镇静机械通气期间维持Richmond躁动镇静评分量表(RASS)评分-1^-2分,拔管后详细记录谵妄的发生情况及持续时间,比较两组患者拔除气管插管后谵妄发生率。结果 M组谵妄发生率为25.0%(17/68),ICU滞留时间为(2.49±0.50)d,均明显高于MP组的10.2%、(2.29±0.59)d,差异具有统计学意义(P<0.05)。两组患者的谵妄持续时间比较差异无统计学意义(P>0.05)。结论咪达唑仑复合丙泊酚治疗拔除气管插管后患者的谵妄发生率较低,可缩短ICU滞留时间,但复合丙泊酚后不能缩短谵妄持续时间。Objective To investigate occurrence of delirium between midazolam and midazolam combined with propofol in intensive care unit（ICU）mechanical ventilation patients after trachea cannula extubation. Methods A total of 127 patients receiving ICU mechanical ventilation and sedation therapy were divided by their sedative administration measures into midazolam group（group M, 68 cases）and midazolam combined with propofol transitive group（group MP, 59 cases）. Both groups received the same midazolam dosage[ intravenous injection 2~3 mg followed by 0.05 mg/（kg·h）] for venous pump maintenance. Respiratory ventilation parameter model was regulated to CPAP/PSV model when patients had stable hemodynamics, along with pressure support as 8~10 cm H_2O（1 cm H_2O=0.098 k Pa）, tidal volume 400 ml, breathing rate 25 times/min, oxygen concentration 45% and good autonomous respiration. Extubation in group M was made after midazolam venous pump withdrawal. Group MP received propofol[ 0.5~4.0mg/（kg·h）] for sedation for 2 h instead of midazolam in 2 h before extubation, and extubation was made with standard machine withdrawal condition after drug withdrawal（combined with revival plan）. Richmond agitation sedation scale（RASS）score was kept in-1^-2 points during sedation mechanical ventilation. Detailed records were made on delirium condition and times after extubation to compare incidences of delirium after extubation between two groups. Results Group M had all much higher incidence of delirium as 25.0%（17/68）and ICU stay time as（2.49±0.50）d than 10.2% and（2.29±0.59）d in group MP, and the difference had statistical significance（P〈0.05）. There was no statistically significant difference of delirium duration between the two groups（P〈0.05）. Conclusion Combination of midazolam and propofol in treating delirium patients after trachea cannula extubation shows low incidence of delirium and shortened ICU stay time, while this method has no affect on shortening delirium duration.

关 键 词：咪达唑仑 谵妄 丙泊酚 镇静 

分 类 号：R459.7[医药卫生—急诊医学]