气管插管机械通气患者的镇静管理

Sedation management in patients undergoing mechanical ventilation： observation of 98 patients

目的探讨气管插管机械通气患者插管期间的镇静管理，为临床实践提供依据。方法采集重症监护病房98例气管插管患者插管期间的镇静管理相关资料，进行分析、总结。结果98例患者使用镇静药物后0．5h和1h的呼吸、心率、血压、氧饱和度发生明显变化。5例患者出现延迟拔管，11例出现一过性血压下降，3例出现神经系统抑制过深，1例出现甘油三酯过高。结论对镇静治疗的患者做好镇静评估、循环功能的管理、呼吸功能的管理、神经系统的管理、药物代谢的管理、环境的管理和减少应激因素及预防并发症的管理是镇静治疗能否顺利进行的关键。

Objective To investigate the importance of sedation management in patients undergoing mechanical ventilation. Methods 98 patients, 55 males and 43 females, aged 53 （18-84）, after heart or biliary tract operation, or with acute cardiac infection, multiple injuries, or advanced cancer underwent mechanical ventilation by tracheal incubation and administration of sedatives. Assessment of sedation was performed every 5 min at first, and then every 2~4 hours 1 hour after the infusion speed of propofol became stable. Propofol failed to reach the desired effect in 31 patients, midazolam was administered in addition. Results Increase of respiratory rate and decrease of tidal volume were seen. Transient lowering of blood pressure was seen in 11 patients. The patients administered with midazolam awoke after 2 hours, a time longer than that of the patients administered with propofol only. The patients under sedation assessment remained sensitive to light and noise. Delay of extubation was seen in 5 patients. Too deep inhibition of nervous system was found in 3 cases. Serum triglyceride was raised in one case. Conclusion Sedation assessment, management of functions of circulatory, respiratory, and nervous systems, drug metabolism, and environment, and prevention of complicated diseases are important during mechanical ventilation.