丙泊酚与咪达唑仑对无创正压通气治疗患者预后的影响比较  

Effects of propofol and midazolam on the prognosis of patients treated with noninvasive positive pressure ventilation

作　　者：窦红杰 胡芳宝 王文[1] 凌林 王德强 王槐青 刘芬莲 葛广豪[2] 翁浩[1] Dou Hongjie;Hu Fangbao;Wang Wen;Ling Lin;Wang Deqiang;Wang Huaiqing;Liu Fenlian;Ge Guanghao;Weng Hao(Department of ICU, the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University(South Campus), Shanghai 201499, China;Department of Cardiology, the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University(South Campus), Shanghai 201499, China)

机构地区：[1]上海交通大学附属第六人民医院南院重症医学科,201499 [2]上海交通大学附属第六人民医院南院心内科,201499

出　　处：《中国基层医药》2019年第5期587-591,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：上海市奉贤区科学技术委员会课题(20141311).

摘　　要：目的比较丙泊酚与咪达唑仑对无创正压通气治疗患者预后的影响。方法以2014年10月至2016年12月上海交通大学附属六院南院重症医学科收治的急性呼吸困难需应用无创通气治疗的患者90例为研究对象,采用随机数字表法分为三组:对照组(30例)不予镇静治疗;丙泊酚组(30例)给予0.5~1 mg/kg负荷量后,用微量泵静脉输注1 mg·kg^-1·h^-1进行维持;咪达唑仑组(30例)给予0.05~0.1 mg/kg负荷量后,微量泵静脉输注0.05~0.1 mg·kg^-1·h^-1进行维持,患者的镇静目标均为Ramsay评分为2级。比较各组的气管插管率、医院感染发生率、住ICU时间、住院时间、病死率及镇静相关的并发症。结果丙泊酚组气管插管率[20.0%(6/30)]与咪达唑仑组[23.3%(7/30)]差异无统计学意义(χ^2=2.65,P>0.05),对照组气管插管率[46.7%(14/30)]均明显高于丙泊酚组、咪达唑仑组(χ^2=4.21、4.17,均P<0.05);丙泊酚组住ICU时间、住院时间分别为(7±3)d、(15±5)d,咪达唑仑组分别为(8±4)d、(16±4)d,对照组分别为(13±4)d、(20±6)d,丙泊酚组、咪达唑仑组住ICU时间、住院时间均较对照组明显缩短(t=2.384、2.371,2.392、2.389,均P<0.05);对照组30 d病死率、90 d病死率分别为20.0%(6/30)、30.0%(9/30),丙泊酚组分别为10.0%(3/30)、20.0%(6/30),咪唑达仑组分别为13.3%(4/30)、23.3%(7/30),三组差异均无统计学意义(均P>0.05);丙泊酚组、咪达唑仑组医院感染率发生率分别为6.7%(2/30)、10.0%(3/30),差异无统计学意义,两组均明显低于对照组的33.3%(10/30)(χ^2=4.32、4.23,均P<0.05)。结论对于伴有躁动的急性呼吸困难患者,使用无创呼吸机后,早期应用轻度镇静治疗,可以提高患者的耐受率,降低行气管插管的概率及医院感染发生率,缩短住ICU时间,无明显不良反应,使用丙泊酚与咪达唑仑无明显差异。Objective To compare the effects of propofol and midazolam on the prognosis of patients treated with noninvasive positive pressure ventilation. Methods A prospective, single-blind, randomized controlled trial(RCT) was conducted in 90 patients who were treated with noninvasive ventilation for acute dyspnea in the ICU of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from October 2014 to December 2016.They were randomly divided into three groups according to the digital table, with 30 cases in each group.The control group was not given sedation treatment.The propofol group was given propofol 0.5~1 mg/kg, and then administered by intravenous infusion of 1 mg·kg^-1·h^-1 with a micropump.The midazolam group was given midazolam 0.05-0.1mg/kg, and then with intravenous infusion of 0.05-0.1 mg·kg^-1·h^-1 maintaining the patients' sedation goals(Ramsay score of 2). The vital signs and blood gas analysis indicators were recorded.The incidence of tracheal intubation, the incidence of hospital infection, length of ICU and hospital stay, mortality and sedation-related complications were compared. Results The tracheal intubation rate in the propofol group was similar to that in the midazolam group(20.0% vs.23.3%,χ^2=2.65, P>0.05), while the tracheal intubation rate(46.7%) in the control group was significantly higher(χ^2=4.21, 4.17, all P<0.05). The length of ICU and hospital stay in the propofol group[(7±3)d and (15±5)d]and midazolam treatment group[(8±4)d and (16±4)d]were significantly shorter than those in the control group[(13±4)d and (20±6)d](t=2.384, 2.371, 2.392, 2.389, all P<0.05). The mortality rates of 30d (20.0%, 6/30) and 90d (30.0%, 9/30) in the control group were higher than those in the propofol group(10.0%, 3/30;20.0%, 6/30), and the midazolam group(13.3%, 4/30;23.3%, 7/30), but the differences were not statistically significant(P>0.05). The incidence rates of hospital infection in the propofol group and midazolam group were 6.6%(2 cases) and 10.0%(3 cases), which were sign

关 键 词：丙泊酚 咪达唑仑 镇静 连续气道正压通气 呼吸 人工 呼吸困难 交叉感染 预后 疗效比较研究 

分 类 号：R614[医药卫生—麻醉学]