丙泊酚与咪达唑仑联合镇静作用在机械通气中的研究

目的分析机械通气过程中丙泊酚与咪达唑仑联合镇静效果。方法选择我院2010年6月至2011年5月在重症医学科救治的37例需机械通气同时镇静治疗的危重患者。所有入选患者给予丙泊酚1．0～1．5mg／kg体质量静脉注射快速镇静，然后经口气管插管，机械通气后患者清醒，出现烦躁时给予咪达唑仑0．05。0．1mg/k体质量行镇静诱导，之后以0．05～0．10mg·kg^-1·h^-1的剂量，用静脉泵持续泵入，以获得2-4级Ramsay镇静评分。分别记录两药静脉推注后镇静起效时间、达满意镇静深度的时间，记录给予咪达唑仑前，用药后2、6h患者的心率、呼吸、血压、动脉血气分析结果。结果在负荷剂量下所有患者均能够达到镇静效果，Ramsay评分在2～4级，丙泊酚镇静诱导时间及达满意深度时间（29±4）s，（20±3）min]明显快于咪达唑仑（66±4）s，（41±5）min]，差异有统计学意义（P〈0．01）；咪达唑仑在维持剂量时能保持良好镇静效果。咪达唑仑用药2、6h后心率、血压、呼吸、血氧饱和度（SpO2）及动脉血氧分压（PaO2）均较用药前明显改善（P〈0．01）。结论气管插管时静脉推注丙}自酚可快速镇静、解痉；咪达唑仑在机械通气的镇静维持治疗中取得很好效果，而且安全。

Research of sedative effects of propofol together with midazolam on patients with mechanical ventilation

Objective To analyze the sedative effect of propofol together with midazolam on mechanical ventilation patients.Methods Thirty-seven patients who required mechanical ventilation and sedated by propofol united with mid-azolam from June 2010 to May 2011 were selected in intensive care unit of the Fifth People′s Hospital of Datong.First,all the selected patients were injected intravenously by propofol(1.0-1.5 mg/kg) as sedative induction.Then orotracheal intubation was operated on them when they came round and began to be agitated,midazolam(0.05-0.1 mg/kg) was in-jected intravenously as sedative induction,followed by continuous injection using injecting pump(0.05-0.1 mg·kg-1·h-1) to get ramsay sedation level Ⅱ-Ⅳ.After injection intravenously the two drugs,The sedative starting time and the time arriving to the ideal sedative level were recorded respectively.Heart rate(HR),respiratory rate(RR),blood pressure(BP),parameters of arterial blood gas analysis(ABG) before and after giving midazolam 2 hours and 6 hours were compared.Results All the patients with the two sedative drugs by inductive dose could get Ramsay sedation level Ⅱ-Ⅳ.The onset time and the time of getting to ideal sedative level to take effect in propofol were(29±4) seconds,(20±3) minute,and(66±4) seconds,(41±5) minute in midazolam,showing significant difference(P<0.01).Giving midazolam by continuous injection using injecting pump for 6 hours,HR,RR,SBP,SpO2,PaO2 became better than before(P<0.01).Conclusion The sedation induced by propofol is more effective than that of midazolam during orotracheal intubation on mechanical ventilation,midazolam plays an important role in continuous sedation and it is very safe.