镇静药物对择期手术术后老年患者膈肌活动度及脱机拔管时间的影响  

Effects of sedative drugs on diaphragm activity and the timing of extubation in elderly patients after elective surgery

作　　者：李雯[1] 李娜 王书鹏[1] 刘继喜[3] 孙力超[4] 翟姗姗 吴筱箐 李晨[1] 段军[1] Li Wen;Li Na;Wang Shupeng;Liu Jixi;Sun Lichao;Zhai Shanshan;Wu Xiaoqing;Li Chen;Duan Jun(Surgical Intensive Care Unit,China-Japan Friendship Hospital,Beijing 100029,China;Department of Emergency,People's Hospital of Yantian District,Shenzhen 518000,China;Department of Gastroenterology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Emergency,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院外科重症医学科,北京100029 [2]深圳市盐田区人民医院急诊科,518000 [3]中日友好医院消化内科,北京100029 [4]中日友好医院急诊科,北京100029

出　　处：《中华老年医学杂志》2020年第6期609-612,共4页Chinese Journal of Geriatrics

基　　金：国家自然科学基金青年科学基金项目(81601725);中日友好医院院级科研基金资助课题(2017-2-QN-16);北京协和医学院学科建设项目(201920102304)。

摘　　要：目的用超声评估择期手术术后老年患者应用镇静药物对膈肌活动度及脱机拔管时间的影响。方法将所有符合条件的60例择期手术术后老年患者随机平均分为3组,丙泊酚组、咪达唑仑组以及空白对照组各20例,3组均应用瑞芬太尼镇痛以保持重症医学科疼痛观察工具法(CPOT)评分<3分,丙泊酚组、咪达唑仑组分别给予丙泊酚、咪达唑仑镇静,镇静程度评估表(RASS)评分保持-2分,测量膈肌活动度、记录自手术结束转入外科重症医学科(SICU)至脱机拔管的时间、评估是否发生谵妄,并与未应用镇静药物的对照组进行比较。结果丙泊酚组膈肌活动度为(1.10±0.12)cm,咪达唑仑组膈肌活动度为(1.17±0.30)cm,对照组膈肌活动度为(1.63±0.25)cm,丙泊酚组、咪达唑仑组的膈肌活动度均小于对照组(F=30.170,P=0.000),但丙泊酚组与咪达唑仑组的膈肌活动度比较差异无统计学意义(t=25.340,P=0.615)。丙泊酚组、咪达唑仑组及对照组的脱机拔管时间分别为(1.41±2.08)d、(1.25±1.53)d、(1.19±1.40)d,差异均无统计学意义(F=0.089,P=0.915)。丙泊酚组、咪达唑仑组及对照组谵妄的发生率分别为20.0%(4/20)、55.0%(11/20)及15.0%(3/20),咪达唑仑组谵妄发生率明显高于丙泊酚组(χ^2=5.230,P=0.022)及对照组(χ^2=7.030,P=0.008),但丙泊酚组与对照组比较差异无统计学意义(χ^2=0.170,P=0.677)。结论择期手术术后老年患者应用镇静药物会对膈肌活动度产生影响,丙泊酚与咪达唑仑对膈肌活动度的影响相仿,但丙泊酚与咪达唑仑均不会对择期手术术后老年患者的脱机拔管时间产生影响;与丙泊酚相比,咪达唑仑会使择期手术术后老年患者谵妄的发生率升高。Objective To investigate the effects of sedatives on the activity of the diaphragm assessed by ultrasound and the timing of extubation in elderly patients after elective surgery.Methods All 60 eligible elderly patients were randomly divided into three groups:the propofol group,the midazolam group and the control group(n=20,each group).Remifentanil was used in the three groups to keep the Critical Care Pain Observation Tool(CPOT)score less than 3.Patients in the propofol and midazolam groups were given propofol and midazolam sedation respectively,and the Richmond Agitation Sedation Scale(RASS)score was maintained at-2.Diaphragmatic activity was measured,the time from the end of the operation to extubation was recorded,and delirium was evaluated,and the above results were compared with those of the control group,which did not receive sedatives.Results The activity of the diaphragm was lower in the propofol and midazolam groups than in the control group[(1.10±0.12)cm,(1.17±0.30)cm vs.(1.63±0.25)cm,F=30.170,P=0.000],and there was no significant difference between the propofol group and the midazolam group(t=25.340,P=0.615).There was no significant difference in duration of extubation among the propofol,midazolam and control groups[(1.41±2.08)d,(1.25±1.53)d vs.(1.19±1.40)d,F=0.089,P=0.915].The incidence of delirium was higher in the midazolam group than in the propofol and control groups[55.0%(11/20),20.0%(4/20)vs.15.0%(3/20),χ^2=5.230,P=0.022,χ^2=7.030,P=0.008],but the difference between the propofol group and control group was not statistically significant(χ^2=0.170,P=0.677).Conclusions The application of sedatives after elective surgery has an effect on the activity of the diaphragm in elderly patients,and the effects of propofol and midazolam are similar.However,propofol and midazolam have no influence on the duration of extubation in elderly patients after elective surgery.Compared with propofol,midazolam increases the incidence of delirium in elderly patients after elective surgery.

关 键 词：镇痛 谵妄 手术后期间 

分 类 号：R614[医药卫生—麻醉学]