右美托咪定与咪达唑仑联合应用在机械通气患者中的效果观察  

Effect of Dexmedetomidine Combined with Midazolam in Patients with Mechanical Ventilation

作　　者：卢险峰 LU Xianfeng(Beijing Zhongguancun Hospital,Beijing 100190,China)

机构地区：[1]北京市中关村医院,北京100190

出　　处：《中国医学创新》2022年第14期29-33,共5页Medical Innovation of China

摘　　要：目的:探究右美托咪定与咪达唑仑联合应用于机械通气患者中的效果。方法:选择2019年7月-2021年3月在北京市中关村医院接受机械通气治疗的136例患者为研究对象,随机将其分为对照组和联合组,各68例。对照组采用咪达唑仑,联合组采用咪达唑仑与右美托咪定。比较两组用药前(T_(0))和用药12 h(T_(1))、24 h(T_(2))、48 h(T_(3))时的血流动力学指标[心率(HR)和平均动脉压(MAP)],T_(0)、T_(2)、T_(3)的心率变异性(RVA)[高频功率(HF)、低频功率(LF)及LF/HF]和镇静、镇痛效果、不良反应情况。结果:两组T_(1)、T_(2)、T_(3)时的HR和MAP水平较T_(0)均明显下降(P<0.05),其中T_(0)、T_(1)、T_(2)、T_(3)时对照组HR水平依次降低(P<0.05),联合组T_(1)、T_(2)、T_(3)时的HR水平均明显低于对照组(P<0.05),但两组T_(1)、T_(2)、T_(3)时的MAP水平比较,差异均无统计学意义(P>0.05)。T_(2)、T_(3)时,两组HF、LF水平较T_(0)均明显下降,且两组T_(3)时HF、LF水平均低于T_(2)时(P<0.05),联合组T_(2)、T_(3)时的HF、LF水平均明显低于对照组(P<0.05);两组T_(2)、T_(3)时的LF/HF均明显小于T_(0)(P<0.05),联合组T_(2)、T_(3)时的LF/HF均明显小于对照组(P<0.05)。与对照组比较,联合组达理想镇静效果所需时间、停药后苏醒时间和机械通气时间均明显缩短(P<0.05),瑞芬太尼用量明显减少(P<0.05),总镇静时间明显延长(P<0.05),停药时CPOT评分和呼吸抑制、谵妄发生率均明显下降(P<0.05)。结论:机械通气镇静、镇痛处理中联合使用右美托咪定与咪达唑仑,可有效稳定血流动力学指标,降低插管所致循环反应及自主神经反应,增强对患者的镇静和镇痛管理,提高镇静安全性。Objective:To investigate the effect of Dexmedetomidine combined with Midazolam in patients with mechanical ventilation.Method:A total of 136 patients who received mechanical ventilation in Beijing Zhongguancun Hospital from July 2019 to March 2021 were selected,they were randomly divided into the control group and the combined group,68 cases in each group.The control group was treated with Midazolam,and the combined group was treated with Midazolam and Dexmedetomidine.The hemodynamic indicators[heart rate (HR) and mean arterial pressure (MAP)],heart rate variability (RVA)[high frequency power (HF),low frequency power (LF) and LF/HF],sedative and analgesic effects and adverse reactions were compared between two groups.Result:The HR and MAP levels of the two groups at T_(1),T_(2) and T_(3) were significantly lower than those at T_(0) (P<0.05).The HR level of the control group decreased successively at T_(0),T_(1),T_(2) and T_(3) (P<0.05).The HR levels of the combined group at T_(1),T_(2) and T_(3) were significantly lower than those of the control group (P<0.05),but there were no significant differences in MAP levels between the two groups at T_(1),T_(2) and T_(3) (P>0.05).The levels of HF and LF in the two groups at T_(2) and T_(3) were significantly lower than those at T_(0),and the levels of HF and LF in the two groups at T_(3) were lower than those at T_(2) (P<0.05).The levels of HF and LF in the combined group at T_(2) and T_(3) were significantly lower than those in the control group (P<0.05);the LF/HF in two groups at T_(2) and T_(3) in the control group were significantly lower than those at T_(0) (P<0.05),and the LF/HF at T_(2) and T_(3) in the combined group were significantly lower than those in the control group (P<0.05).Compared with the control group,the time needed to achieve the ideal sedative effect,the recovery time after drug withdrawal and mechanical ventilation time in the combined group were significantly shortened (P<0.05),the dosage of Remifentanil was significantly reduced (P<0.05),the tota

关 键 词：机械通气 镇静 右美托咪定 咪达唑仑 血流动力学 自主神经反应 

分 类 号：R614[医药卫生—麻醉学]