靶控输注异丙酚用于危重病患者镇静的临床研究

目的探讨异丙酚靶控输注在ICU危重病患者镇静应用中的价值.方法前瞻性研究2010年3月至2010年12月我院ICU住院患者40例,随机分为2组（n=20）：A组采用异丙酚恒速静脉输注,先静脉注射异丙酚1.5 mg/kg行镇静诱导,然后以1 mg/（kg.h）静脉输注;B组采用异丙酚靶控输注,以血浆室为靶控目标,初始靶控血药浓度设定为0.3μg/mL.每30 min采用Ramsay镇静评分评估镇静深度,若Ramsay镇静评分小于或大于4级,A组则输注速率增加或减少0.3 mg/（kg.h）,B组则调整靶浓度增加或减少0.1μg/mL.连续监测平均动脉压（MBp）、每搏输出量（SV）、心输出量（CO）和心脏指数（CI）及心率（HR）,比较两种异丙酚输注方法对血流动力学的影响、镇静效果及用药量.结果两组异丙酚输注方法,均在镇静诱导后MBp、SV、CO和CI明显下降,差别有统计学意义（P〈0.01）,心率（HR）无明显变化,差别无统计学意义（P〉0.05）;其余时点均无明显变化,差别无统计学意义（P〉0.05）.镇静过程中B组Ramsay镇静评分4级所占比例（59%）高于A组（43%）（P〈0.05）,B组用药量（459±186）mg少于A组（781±225）mg（P〈0.05）.结论异丙酚靶控输注用于重症患者能够维持稳定的血流动力学.与传统的恒速输注相比,镇静效果更好,用药量更少.

The Clinical Study of Target-controlled Infusion of Propofol for Sedation in ICU Patients

Objective To investigate the application value of target-controlled infusion(TCI)with propofol for sedation in patients in intensive care unit(ICU).Methods Forty patients who were receiving mechanical ventilation in ICU for longer than 48 hours were randomly assigned to one of 2 groups(n=20 in each group):group A and group B.Patients in group A received a bolus of propofol 1.5 mg/kg followed by continuous IV infusion at 1 mg/(kg.h);patients in group B received TCI of propofol(initial target plasma concentra...