异丙酚与咪唑安定在ICU机械通气镇静治疗中的副作用比较

Comparative study on the side effects of propofol and midazolam for the sedative treatment of mechanical ventilation in ICU

目的对异丙酚与咪唑安定在ICU机械通气镇静治疗中的副作用进行比较。方法从2003年6月～2004年6月,80例ICU机械通气病人随机地被分为异丙酚组和咪唑安定组,每组各40例,异丙酚组先静注异丙酚1.5mg/kg行镇静诱导,然后用微量注射泵持续静注异丙酚0.5～4mg/kg/h。咪唑安定组,先静注咪唑安定0.06mg/kg行镇静诱导,以0.03～0.2mg/kg/h的剂量,用注射泵持续静脉内泵入。维持理想的镇静深度约2～3级。观察各项镇静指标。结果镇静持续时间异丙酚组为(28.3±5.6)h,咪唑安定组为(26.8±6.4)h。达到满意镇静深度的时间,异丙酚组为(26.3±7.7)s,咪唑安定组为(62.6±12.3)s,两组比较有显著性差异(P<0.01)。镇静有效率异丙酚组92%,咪唑安定组为90%。停药后苏醒时间异丙酚组为(21.2±15.7)min,咪唑安定组(114±36)min,两组比较有显著性差异(P<0.01)。异丙酚组有6例出现血压下降,发生率为15%,2例出现心率减慢,发生率为5%,1例停药后出现恶心,发生率为2.5%;咪唑安定组有1例出现血压下降,发生率为2.5%,4例停药清醒后再入睡,发生率为10%,5例停药后出现恶心,发生率为12.5%。结论异丙酚和咪唑安定作为ICU的镇静剂安全有效,但在使用过程中应注意异丙酚易引起血压下降,咪唑安定易引起恶心。

Objective To compare the side effects of propofol and midazolam for the sedative treatment of mechanical ventilation in ICU were ramdonly divided into two ICU.Methods From June2003 to June 2004, 80 patients of groups,namely propofol group and midazolam group.Each group was 40 cases.In the propofol group,1.5mg/kg propofol was given by I.V.injection for sedative induction,and then 0.5-4mg/kg/h was given by continuous I.V.infusion.In the midazolam group,0.06 mg/kg was given for sedative induction,and then,0.03-0.2mg/kg/h midazolam was given by continuous I.V.infusion.The sedative level was kept in the Ramsay sedative level Ⅱ-Ⅲ. Results In the continous sedative time,the propofol was 2.83±5.6 hours and midazolam was 268＋.6.4 hous.In the satisfactory sedative time,propofol group was 26.3±6.4 hours.In the satisfactory sedative time,propofol group was 26.3 ±7.7s and midazolam was 62.6±12.3s.There was obvious difference between the both groups （P〈 0.01）. Effective rate of sedation： The propofol group was 92% and midazolam group was 90%. Awaked time ： the propofol group was 21.2±15.7min and midazolam group was 114±36min.There was obvious difference between the both groups（P〈0.01）.In the propofol group,drop of blood pressure was happened in 6 cases（15%）,bradycardia 2 cases（5%）,nausea 1 cases（2.5%）after stopping drug. In the midazolam group,drop of blood pressure was in 1 cases（2.5%）,consciousness to fall asleep in 4 cases （10%）after stopping drug,nausea in 5 cases （12.5%）.Conclusion Propofol and midazolam are safe and effective sedative drugs using in machnical ventiation.However,in the course of application,the propofol can easy induce drop of blood pressure and the midazolam can easy induce nausea.