右美托咪定和咪达唑仑用于机械通气患者镇静效果的比较

A comparison of efficacy of sedation with dexmedetomidine versus midazolam in mechanically ventilated patients

目的比较右美托咪定和咪达唑仑用于机械通气患者镇静的效果。方法拟在镇静下行机械通气治疗24h的重症监护室（ICU）患者60例，年龄20～64岁，体重指数21～25kg／m2，急性生理与慢性健康Ⅱ评分10～25分，采用随机数字表法，将患者随机分为2组（／2=30）：咪达唑仑组（M组）和右美托咪定组（D组）。M组：静脉注射咪达唑仑0．05mg／kg负荷量后，以0．03～0．20mg·kg-1·h-1。的速率静脉输注；D组：静脉注射右美托咪定1μg／kg负荷量后，以0．2～0．7μg·kg-1·h-1的速率静脉输注，维持2组Ramsay镇静评分2～4分。记录镇静期间ICU医生对镇静效果的满意度、低血压和心动过缓的发生情况。记录开始镇静至停止镇静后2h谵妄的发生情况、苏醒时间和苏醒后2h内再入睡的发生情况。结果与M组比较，D组ICU医生对镇静效果的满意度升高，苏醒时间缩短，苏醒后2h内再入睡率和谵妄发生率降低（P〈0．05或0．01），低血压和心动过缓的发生率差异无统计学意义（P〉0．05）。结论右美托咪定用于机械通气患者镇静的效果优于咪达唑仑。

Objective To compare the efficacy of sedation with dexmedetomidine versus midazolam in mechanically ventilated patients. Methods Sixty patients aged 20-64 yr, with body mass index 21-25 kg/m2, APECHE II score 10-25, requiring 24 h of mechanical ventilation in intensive care unit （ICU）, were randomly divided into 2 groups （ n = 30 each） ： midazolam group （ group M ） and dexmedetomidine group （ group D） . A loading dose of midazolam 0.05 mg/kg was injected intravenously, followed by infusion at 0.03- 0.20 mg kg-1. h-1 in group M. A loading dose of dexmedetomidine 1 μg/kg was injected intravenously, followed by infusion at 0.2-0.7μg kg-1 h-1 in group D. Ramsay sedation score was maintained at 2-4. The satisfaction of the doctors in ICU with tbe sedative efficacy, hypotension and bradycardia were recorded. Delirium was recorded starting from the begging of sedation to 2 h after the end of sedation. The emergence time and occurrence of falling asleep again within 2 h after waking were also recorded.Results Compared with M group, the satisfactory level of the doctors in ICU with the sedative efficacy was significantly increased, the emergence time was significantly short- ened and the incidences of falling asleep again within 2 h after waking and delirium were significantly decreased （ P 〈 0.05 or 0.01 ） , and no significant change was found in the incidence of hypotension and bradyeardia in group D （ P 〉 0.05） , Conclusion The efficacy of sedation with dexmedetomidine is better than that of midazolam in mechanically ventilated patients.