异丙酚、咪唑安定用于后颅窝术后保留气管插管患者镇静的临床观察

Study of sedation with propofol and midazolam in postoperative and tracheal intubated patients with posterior fossa craniotomy

目的观察异丙酚和咪唑安定用于后颅窝肿瘤术后保留气管插管患者镇静的临床效果和对呼吸循环的影响。方法将60例择期全麻后颅窝肿瘤手术后保留气管插管躁动的患者随机分为异丙酚组(P组)和咪唑安定组(M组),每组30例。首先分别给予异丙酚0.5mg/kg或咪唑安定0.05mg/kg静脉推注,再给予异丙酚0.5～3mg/(kg.h)或咪唑安定0.05～0.2mg/(kg.h)微量泵泵入,维持Ramsay镇静评分2～3级,于镇静前及镇静后10min、30min、1h、2h、4h、8h记录Ramsay镇静评分、用药量、心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)。结果起效时间P组为(28±11)s,M组为(45±13)s,两组有显著性差异;苏醒时间M组为(37±16)min,较P组的(24±7)min长,有显著性差异(P<0.05)。镇静期间两组患者HR、RR均较镇静前显著下降(P<0.05),而SBP、DBP、MAP、SpO2均无明显变化,组间比较无显著性差异。结论异丙酚起效时间明显快于咪唑安定,苏醒时间明显短于咪唑安定,二者在镇静剂量下对呼吸和循环的抑制轻微,用于后颅窝术后带气管插管患者镇静是安全有效的。

Objective To determine the effect of sedation of propofol and midazolam in postoperative and tracheal intubated patients with posterior fossa craniotomy. Methods 60 patients undergoing posterior fossa eraniotomy with endotracheal intubation were randomly divided into Propofol group （group P, n = 30）and Midazolam group（ group M, n = 30）. Sedation parameters （ Ramsay score）, hemedynamie parameters （ HR, SBP, DBP, MAP） and respiratory parameters （SpO2, RR） were recorded before sedation , 10min ,30min , lh, 2h, 4h and 8h after sedation. Results Propofol had faster onset of sedation and shorter recovery than midazolam [ （ 28 ± 11 ） s vs. （45 ± 13 ） s, （ 24 ± 7 ） min vs. （ 37 ± 16 ） min] （ P 〈 0.05 ）. During sedation, HR and RR decreased significantly （ P 〈 0.05 ） in both groups. No significant difference in SBP, DBP, MAP and SpO2 were observed. Conclusions Propofol and midazolam are both safe and effective in postoperative and tracheal intubated patients with posterior fossa eraniotomy.