右美托咪定或咪达唑仑复合舒芬太尼在有创机械通气患者镇静中的效果对比
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摘要
目的探讨右美托咪定或咪达唑仑复合舒芬太尼在有创机械通气中的镇静效果。方法选取2017年6月～2018年6月来我院行有创机械通气的102例患者,按随机数字表法分为对照组和观察组,每组各51例,对照组采取咪达唑仑复合舒芬太尼镇静方案,观察组采取右美托咪定复合舒芬太尼镇静方案,比较两组机械通气时间、唤醒时间、住ICU时间及不良反应发生情况,同时分别于用药前、用药后6、12、24 h监测两组的Ramsay评分、心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)指标。结果观察组机械通气时间、唤醒时间短于对照组(P<0.05);而两组住ICU时间比较,差异无统计学意义(P>0.05);观察组不良反应总发生率低于对照组(P<0.05);两组用药后6、12、24 h时HR、MAP水平较用药前均降低,SpO_2水平升高,且观察组HR、MAP低于对照组,SpO_2水平高于对照组(P<0.05);两组用药后6、12、24 h时Ramsay评分较用药前均升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论对有创机械通气患者采取右美托咪定复合舒芬太尼方案可取得良好的镇静效果,能稳定患者生命体征,且不良反应少。
Objective To explore the sedative effect of Dexmedetomidine or Midazolam combined with Sufentanil in invasive mechanical ventilation. Methods Selected 102 patients with invasive mechanical ventilation in our hospital from June 2017 to June 2018, according to random number table method, they were divided into control group and observation group, 51 cases in each group. The control group was sedated by Midazolam combined with Sufentanil, while the observation group was sedated by Dexmedetomidine combined with Sufentanil. The mechanical ventilation time,awakening time, ICU time and adverse reactions were compared between the two groups. Ramsay score, heart rate(HR), mean arterial pressure(MAP) and blood oxygen saturation(SpO_2) were monitored before and 6, 12 and 24 hours after treatment. Results The mechanical ventilation time and wake-up time in the observation group were shorter than those in the control group(P<0.05), but there was no statistical difference between the two groups when they were living in ICU(P>0.05); the total incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05). The levels of HR and MAP in the two groups at 6, 12 and 24 h after treatment was lower than those before treatment, the spO_2 level increased, and HR and MAP in the observation group were lower than those in the control group, SpO_2 level was higher than that of control group(P<0.05). The Ramsay scores of the two groups at 6, 12 and 24 hours after treatment was higher than those before treatment, and that of the observation group was higher than that of the control group(P <0.05). Conclusion Dexmedetomidine combined with Sufentanil for invasive mechanical ventilation patients can achieve good sedative effect, stabilize the vital signs of patients, and have fewer adverse reactions.
Objective To explore the sedative effect of Dexmedetomidine or Midazolam combined with Sufentanil in invasive mechanical ventilation. Methods Selected 102 patients with invasive mechanical ventilation in our hospital from June 2017 to June 2018, according to random number table method, they were divided into control group and observation group, 51 cases in each group. The control group was sedated by Midazolam combined with Sufentanil, while the observation group was sedated by Dexmedetomidine combined with Sufentanil. The mechanical ventilation time,awakening time, ICU time and adverse reactions were compared between the two groups. Ramsay score, heart rate(HR), mean arterial pressure(MAP) and blood oxygen saturation(SpO_2) were monitored before and 6, 12 and 24 hours after treatment. Results The mechanical ventilation time and wake-up time in the observation group were shorter than those in the control group(P<0.05), but there was no statistical difference between the two groups when they were living in ICU(P>0.05); the total incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05). The levels of HR and MAP in the two groups at 6, 12 and 24 h after treatment was lower than those before treatment, the spO_2 level increased, and HR and MAP in the observation group were lower than those in the control group, SpO_2 level was higher than that of control group(P<0.05). The Ramsay scores of the two groups at 6, 12 and 24 hours after treatment was higher than those before treatment, and that of the observation group was higher than that of the control group(P <0.05). Conclusion Dexmedetomidine combined with Sufentanil for invasive mechanical ventilation patients can achieve good sedative effect, stabilize the vital signs of patients, and have fewer adverse reactions.
引文
[1]田国欣,李爱光.COPD急性加重期患者机械通气治疗中右美托咪定的镇静效果观察[J].临床医学研究与实践,2016,1(27):113-114.
[2]谭明华,黄燕.舒芬太尼联合右美托咪定在ICU机械通气患者中的临床应用价值[J].中国医学前沿杂志(电子版),2016,8(1):69-72.
[3]沈萍.咪哒唑仑结合芬太尼对重症手足口病机械通气患儿的镇静疗效观察[J].黑龙江医学,2014,38(9):1075-1076.
[4]孙立新,王彬,马福国,等.胸椎旁神经阻滞用于微创冠状动脉旁路移植术患者超前镇痛的效果[J].中华麻醉学杂志,2016,36(2):171-174.
[5]裘剑波,齐超,林家燕,等.依托咪酯与丙泊酚复合咪哒唑仑及芬太尼麻醉在老年患者无痛结肠镜检查治疗中的比较[J].中国内镜杂志,2014,20(3):313-316.
[6]黄立,许吉生.ICU机械通气患者中右美托咪定与舒芬太尼的临床应用[J].中国生化药物杂志,2017,37(8):197-199.
[7]周姝,邢永生.舒芬太尼与地佐辛分别联合右美托咪定在重症心衰合并机械通气患者镇痛镇静中应用比较[J].中国现代药物应用,2017,11(18):84-86.
[8]王键.舒芬太尼联合右美托咪啶对ICU气管插管机械通气COPD急性加重期患者呼吸抑制率及康复进程的影响[J].实用中西医结合临床,2017,17(7):28-29.
[9]张友华,吕光宇,张磊,等.右美托咪定与丙泊酚在心脏术后患者机械通气中应用的对比研究[J].中国临床新医学,2015,8(5):419-422.
[10]杨明全,周洁,曹建伟,等.ICU机械通气患者右美托咪定镇静的安全性评价[J].中华危重病急救医学,2016,28(9):839-844.
[11]付春,安友仲.“冷静”药物盐酸右美托咪定对重症加强治疗病房术后机械通气患者镇痛镇静和脱机拔管的影响[J].中国中西医结合急救杂志,2016,23(4):442-445.
[12]姜晓东,付新磊,于健.瑞芬太尼联合右美托咪定在ICU机械通气患者镇痛镇静中的作用[J].大连医科大学学报,2018,40(5):408-411,423.
[13]郭瑞.ICU机械通气患者右美托咪定镇静的效果评价[J].内蒙古医学杂志,2017,49(10):1240-1242.
[14]李理,徐道妙.右美托咪啶联合舒芬太尼用于重症急性胰腺炎患者镇静镇痛的临床研究[J].中国医师杂志,2016,18(5):688-691.
[15]钟小东,陈学清,王晨,等.右美托咪啶联合舒芬太尼在ICU慢性阻塞性肺疾病急性加重期患者有创机械通气中的应用[J].中华全科医学,2015,13(5):766-768.
[2]谭明华,黄燕.舒芬太尼联合右美托咪定在ICU机械通气患者中的临床应用价值[J].中国医学前沿杂志(电子版),2016,8(1):69-72.
[3]沈萍.咪哒唑仑结合芬太尼对重症手足口病机械通气患儿的镇静疗效观察[J].黑龙江医学,2014,38(9):1075-1076.
[4]孙立新,王彬,马福国,等.胸椎旁神经阻滞用于微创冠状动脉旁路移植术患者超前镇痛的效果[J].中华麻醉学杂志,2016,36(2):171-174.
[5]裘剑波,齐超,林家燕,等.依托咪酯与丙泊酚复合咪哒唑仑及芬太尼麻醉在老年患者无痛结肠镜检查治疗中的比较[J].中国内镜杂志,2014,20(3):313-316.
[6]黄立,许吉生.ICU机械通气患者中右美托咪定与舒芬太尼的临床应用[J].中国生化药物杂志,2017,37(8):197-199.
[7]周姝,邢永生.舒芬太尼与地佐辛分别联合右美托咪定在重症心衰合并机械通气患者镇痛镇静中应用比较[J].中国现代药物应用,2017,11(18):84-86.
[8]王键.舒芬太尼联合右美托咪啶对ICU气管插管机械通气COPD急性加重期患者呼吸抑制率及康复进程的影响[J].实用中西医结合临床,2017,17(7):28-29.
[9]张友华,吕光宇,张磊,等.右美托咪定与丙泊酚在心脏术后患者机械通气中应用的对比研究[J].中国临床新医学,2015,8(5):419-422.
[10]杨明全,周洁,曹建伟,等.ICU机械通气患者右美托咪定镇静的安全性评价[J].中华危重病急救医学,2016,28(9):839-844.
[11]付春,安友仲.“冷静”药物盐酸右美托咪定对重症加强治疗病房术后机械通气患者镇痛镇静和脱机拔管的影响[J].中国中西医结合急救杂志,2016,23(4):442-445.
[12]姜晓东,付新磊,于健.瑞芬太尼联合右美托咪定在ICU机械通气患者镇痛镇静中的作用[J].大连医科大学学报,2018,40(5):408-411,423.
[13]郭瑞.ICU机械通气患者右美托咪定镇静的效果评价[J].内蒙古医学杂志,2017,49(10):1240-1242.
[14]李理,徐道妙.右美托咪啶联合舒芬太尼用于重症急性胰腺炎患者镇静镇痛的临床研究[J].中国医师杂志,2016,18(5):688-691.
[15]钟小东,陈学清,王晨,等.右美托咪啶联合舒芬太尼在ICU慢性阻塞性肺疾病急性加重期患者有创机械通气中的应用[J].中华全科医学,2015,13(5):766-768.