右美托咪定和咪达唑仑复合芬太尼对ICU术后机械通气患者镇静的影响

目的观察右美托咪定和咪达唑仑复合芬太尼用于ICU术后机械通气患者的镇静效果及安全性。方法选取150例ICU术后机械通气患者,采用信封法随机分为右美托咪定组和咪达唑仑组,每组75例,两组患者均给予芬太尼持续泵入。右美托咪定组采用右美托咪定0.2～0.6μg/(kg·h)持续泵入。咪达唑仑组采用0.08～0.10 mg/(kg·h)咪达唑仑持续泵入。采用Ramsay分级标准对两组患者镇静效果进行分级评分,观察两组患者的镇静效果。详细记录两组患者芬太尼用量、达到理想镇静所需的时间、停药后苏醒时间、镇静期间呼吸及循环系统功能的变化及其他不反应发生情况。结果右美托咪定组镇静满意率为97.33%,咪达唑仑组镇静满意率为96.00%,两组镇静满意率比较差异无统计学意义(P>0.05)。右美托咪定组芬太尼用量明显低于咪达唑仑组(P<0.05),达到理想镇静所需时间及停药后苏醒时间明显短于咪达唑仑组(P<0.05)。两组患者呼吸抑制、平均动脉压下降、SpO2下降及恶心发生率比较差异无统计学意义,但右美托咪定组谵妄发生率明显低于咪达唑仑组,两组比较差异有统计学意义(P<0.05)。结论右美托咪定复合芬太尼用于ICU术后机械通气患者的镇静治疗,镇静效果满意,可以达到理想镇静时间及易唤醒时间短,谵妄发生率低,可减少芬太尼用量,而且对患者呼吸及循环系统影响小,是一种较为理想的ICU镇静剂。

Efficacy of dexmedetomidine and midazolam combined with fentanyl on sedation ofpostoperative and mechanically ventilated ICU patients

Objective To observe the sedative effects and safety of dexmedetomidine and midazolam com- bined with fentanyl on postoperative and mechanically ventilated ICU patients. Methods 150 cases of postoperative and mechanically ventilated ICU patients were randomly divided into dexmedetomidine group and midazolam group u- sing the envelope method,75 cases in each group. Patients in the two groups were given continuous infusion of fenta- nyl. Dexmedetomidine group were given fixed 0. 2 -0. 6 μg/（ kg. h） dexmedetomidine continuous infusion. Midazolam group were given 0. 08 -0. 10 mg/（ kg. h） midazolam continuous infusion. Calming effect of the two groups was gra- ded using the grading criteria Ramsay score, and the sedative effect was observed. Dosage of fentanyl, the time required to achieve the desired sedation, recovery time after treatment, the respiratory and circulatory function changes during the sedation and other effects were recorded. Results The satisfaction rate of dexmedetomidine group and midazolam group were 97.33 % and 96. 00% , there was no significant difference between the two groups （P 〉 0. 05 ）. The dosage of fentanyl of dexmedetomidine group was significantly lower than that of midazolam group （ P 〈 0. 05 ） , the time re- quired to achieve the desired sedation and recovery time after treatment were significantly lower than those of midazo- lain group （ P 〈 0. 05 ）. The respiratory depression, decreased mean arterial pressure, SpO2 decreased and nausea had significant difference between the two groups, but the incidence of delirium midazolam of dexmedetomidine group was significantly lower than that of midazolam group （ P 〈 0. 05 ）. Conclusion Dexmedetomidine combined with fentanyl in postoperative and mechanically ventilated ICU patients has satisfactory calming effect, can achieve the desired dura- tion of sedation and easy to wake up,has a low incidence of delirium, can reduce the amount of fentanyl, and has small influence on patient breathing and circulatory system, it is an ideal ICU sedative.