咪达唑仑与丙泊酚用于老年体外循环心脏术后机械通气患者的临床研究  

Clinical trial of midazolam and propofol in the treatment of elderly patients undergoing mechanical ventilation after cardiopulmonary bypass cardiac surgery

作　　者：吴恩刚 董圣军[1] 盖宁 刘宝辉[1] 刘典晓[1] 王锋[1] 杨凯强 王倩倩[2] WU En-gang;DONG Sheng-jun;GAI Ning;LIU Bao-hui;LIU Dian-xiao;WANG Feng;YANG Kai-qiang;WANG Qian-qian(Departmentot f Cardiac Vascular Surgery,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China;Department f Anesthesiology,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China)

机构地区：[1]滨州医学院附属医院心脏大血管外科,山东滨州256600 [2]滨州医学院附属医院麻醉科,山东滨州256600

出　　处：《中国临床药理学杂志》2024年第7期963-967,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的分析咪达唑仑与丙泊酚用于老年体外循环(CPB)心脏术后机械通气患者对镇静效果及血气指标的影响。方法将老年CPB心脏术后机械通气患者按队列法分为咪达唑仑组(M组)、丙泊酚组(P组)和咪达唑仑与丙泊酚联合给药组(M-P组)。M组静脉注射0.05~0.10mg·kg^(-1)咪达唑仑进行镇静诱导,再通过微量泵持续静脉泵入0.05~0.15mg·kg^(-1)·h^(-1)咪达唑仑;P组静脉注射0.5~1.0mg·kg^(-l)丙泊酚进行镇静诱导,再通过微量泵持续静脉泵入0.5~2.0mg·kg^(-1)h^(-1)丙泊酚;M-P组首先静脉注射0.02~0.05mg·kg^(-l)咪达唑仑及0.2~0.5mg·kg^(-l)丙泊酚进行镇静诱导,再继续持续静脉泵入0.05~0.1 mg·kg^(-l)咪达唑仑及0.5~0.8mg·kg^(-l)·h^(-l)丙泊酚。比较3组患者的镇静效果、血气指标、血流动力学指标、拔管时间、重症监护病房(ICU)滞留时间及治疗费用,并记录镇静治疗期间的药物不良反应发生情况。结果M组、P组和M-P组分别有43例、44例和39例。M组、P组和M-P组的药物起效时间分别为(77.94±12.05)、(18.18±5.20)和(21.25±9.36)s,达到满意镇静效果时间分别为(42.57±11.41)、(22.63±8.17)和(23.98±10.25)min,停药后苏醒时间分别为(59.30±14.86)、(19.83±5.44)和(22.16±6.29)min,拔管时间分别为(1.61±0.20)、(1.45±0.22)和(1.37±0.15)d,ICU滞留时间分别为(2.17±0.29)、(1.91±0.36)和(1.84±0.25)d,治疗费用分别为(186.59±60.83)、(922.97±164.34)和(375.03±71.16)千元,药物不良反应总发生率分别为34.88%、4.55%和7.69%,在统计学上差异均有统计学意义(均P<0.05);3组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)各时间点平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))比较,在统计学上差异均无统计学意义(均P>0.05)。结论咪达唑仑与丙泊酚联合给药用于老年CPB心脏术后机械通气患者具有显著的镇静效果,有利于减少镇静药物用量,且对患者血气�Objective To analyze the influence of midazolam and propofol on sedation effect and blood gas indicators in elderly patients undergoing mechanical ventilation after cardiopulmonary bypass(CPB)cardiac surgery.I Methods The elderly patients with mechanical ventilation after CPB cardiac surgery were grouped according to cohort method,including midazolam group(group M),propofol group(group P)and midazolam-propofol combined administration group(group M-P).Group M was treated with midazolam(intravenous injection of 0.05-0.10 mg·kg^(-1)midazolam for sedation induction,and then continuously intravenous injection of 0.05-0.15 mg·kg^(-1)·h^(-1)midazolam by micropump),and group P was treated with propofol(intravenous injection of O.5 mg kg^(-1)propofol for sedation induction,and then continuously intravenous injection of 0.5-2.0 mg·kg^(-1)·h^(-1)propofol by micropump),and group M-P was given combined administration of midazolam and propofol(intravenous injection of 0.02-0.05 mg·kg^(-1)midazolam and 0.2-0.5 mg·kg^(-1)propofol for sedation induction and then continuously intravenous pump of 0.05-0.1 mg·kg^(-1)midazolam and 0.5-0.8 mg·kg^(-1)·h^(-1)propofol).The sedation effect,blood gas indicators,hemodynamic indicators,extubation time,intensive care unit(ICU)stay time and treatment cost were compared among the three groups,and the adverse drug reactions during sedation therapy were recorded.Results There were 43 cases in group M,44 cases in group P,39 cases in group M-P.The drug onset times in groups M,P and M-P were(77.94±12.05),(18.18±5.20)and(21.25±9.36)s;the times to achieve satisfactory sedation effect were(42.57±11.41),(22.63±8.17)and(23.98±10.25)min;the recovery times after withdrawal were(59.30±14.86),(19.83±5.44)and(22.16±6.29)min;the extubation times were(1.61±0.20),(1.45±0.22)and(1.37±0.15)d;the ICU stay times were(2.17±0.29),(1.91±0.36)and(1.84±0.25)d;the treatment costs were(186.59±60.83),(922.97±164.34)and(375.03±71.16)thousand yuan;and the total incidence rates of adverse drug react

关 键 词：咪达唑仑 丙泊酚 老年 体外循环 机械通气 镇静 血气指标 

分 类 号：R971.2[医药卫生—药品]