异丙酚和芬太尼长期镇静对机械通气时血流动力学的影响

Hemodynamic Effects of Propofol and Fentanyl on Critically Ill Patients for Long term Sedation During Mechanical Ventilation

目的：观察异丙酚和芬太尼混合液对危重病人机械通气期间血流动力学的影响。方法：２４例病人随机分为对照组（ｎ＝１１）：机械通气期间间断用咪唑安定５～１０ｍｇ或芬太尼０．１～０．２ｍｇ静脉注射；异丙酚组（ｎ＝１３）：机械通气期间持续静滴异丙酚４００ｍｇ加芬太尼０．５ｍｇ混合液２ｍｇ·ｋｇ－１·ｈ－１。结果：入ＩＣＵ时两组心脏指数、血液饱和指数无差异，异丙酚组心脏指数逐渐升高，在入ＩＣＵ后第二天明显升高（Ｐ＜０．０５）。异丙酚组血液饱和指数增加显著（Ｐ＜０．０１），且与用药前相比增加显著（Ｐ＜０．０１）。异丙酚组病人平均主动脉压较对照组有所下降，但无统计学意义。异丙酚可使肺动脉压轻度下降，在以后的治疗中两组无差别。心率、中心静脉压、肺毛细血管楔压无明显变化。入ＩＣＵ时两组全身血管阻力无差异，异丙酚可降低全身血管阻力，在入ＩＣＵ后第二天下降明显（Ｐ＜０．０５）。异丙酚可使周围血管阻力下降（Ｐ＜０．０５）。结论：异丙酚和芬太尼混合液长期镇静对危重病人机械通气期间的血流动力学影响较小。

Objective:This article was to investigate the hemodynamic effects of the mixture from propofol and fentanyl on propofol critically ill patients for prolonged sedation during mechanical ventilation.Methods: 24 patients were admitted to ICU with mechanical ventilation and sedation started as required. Eleven patients were assigned to placebo group receiving midazolam 5 10 mg or fentanyl 0.1 0.2 mg i.v;and thirteen to propofol group recieving infusion of a mixture from propofol 400 mg and fentanyl 0.5 mg at 2 ml·kg -1 ·h -1 for a maximum of 4 days. Results:CI and SI increased significantly in propofol group on the second day of adminision to ICU ( P <0.01). MAP and PAP decreased lightly,but the differences were not significant. HR,CVP and PCWP were found to have no changes in either group. Propofol significantly decreased SVRI and PVRI on the second day of adminision ( P <0. 05).Conclusion:Infusion of mixed liquid for propofol and fentanyl could provide satisfactory sedation for ICU patients with little hemodynamic changes.