咪唑安定與丙泊酚小劑量聯(lián)合應(yīng)用對危重患者鎮(zhèn)靜效果的評價(jià)

摘要： 目的觀察咪唑安定與丙泊酚小劑量聯(lián)合應(yīng)用對機(jī)械通氣患者鎮(zhèn)靜的有效性與安全性。方法選擇需要機(jī)械通氣的危重癥患者26例,除外低血容量、心肺功能不全及嚴(yán)重肝腎功能障礙者。首先給予咪唑安定0.02mg/kg及丙泊酚0.2mg/kg靜脈注射以誘導(dǎo)鎮(zhèn)靜,而后持續(xù)靜脈泵入咪唑安定0.02～0.04mg·kg~(-1)·h~(-1)及丙泊酚0.42～0.64mg·kg~(-1)·h~(-1)以獲得3～5級的Ramsay鎮(zhèn)靜評分。觀察呼吸、循環(huán)參數(shù)指標(biāo),并記錄達(dá)到Ramsay3級時(shí)咪唑安定及丙泊酚的平均劑量、鎮(zhèn)靜劑量,停藥后的蘇醒時(shí)間及不良反應(yīng)。結(jié)果咪唑安定與丙泊酚小劑量聯(lián)合應(yīng)用能達(dá)到滿意的鎮(zhèn)靜效果,呼吸、循環(huán)系統(tǒng)穩(wěn)定,用藥前后動(dòng)脈血氧飽和度及Ramsay評分有明顯的改善。結(jié)論咪唑安定與丙泊酚小劑量聯(lián)合應(yīng)用是一種良好的復(fù)合鎮(zhèn)靜方法。
Objective To observe synergistic sedation of propofol and midazolam used in mechanically ventilating patients in intensive care unit(ICU).Methods Sixteen patients with mechanical ventilation in ICU were assigned to receive propofol combined with midazolam.The patients were injected intravenously with midazolam 0.02mg·kg~(-1) and propofol 0.2 mg·kg~(-1) as a loading dose followed by midazolam 0.02～0.04mg·kg~(-1)·h~(-1)and propofol 0.42～0.64mg·kg~(-1)·h~(-1)infused continuously with a pump.The dose infused was adjusted according to Ramsay classification standard.The dosage,heart rate,breathing rate,blood pressure,arterial oxygen saturation before and after using the drugs and recovery time were recorded when gradeⅢof Ramsay classification were reached.Results Adequate sedation were achieved(100%).The respiratory and circulation parameters were stable.The recovery time was shorter.Conclusion Combined application of propofol and midazolam is an effective and safe alternative for sedation.