右美托咪啶和咪达唑仑用于危重症患者镇静效应的比较

Exmedetomidine vs Midazolam for Sedation in critically ill patients

目的：比较右美托咪啶和咪达唑仑用于危重症患者镇静的效应。方法：将2010年10月~2011年2月本院重症医学科收治的需要镇静、镇痛的60例患者随机分为右美托咪啶组和咪达唑仑组,每组各30例。右美托咪啶组经静脉泵入负荷剂量的右美托咪啶1μg/kg静脉泵注10 min,继以0.2~0.7μg.kg-1.h-1维持;咪达唑仑组给予负荷剂量咪达唑仑0.05 mg/kg静脉泵注1 min,再以0.02~0.1mg.kg-1.h-1维持。比较两组患者镇静满意程度、机械通气时间、药物停止使用后至唤醒所需时间、谵妄发生率。结果：通过调整药物剂量使两组患者Ramsay评分均在2~4分时,镇静满意程度右美托咪啶组（83.3%）明显高于咪达唑仑组（33.3%）,差异有统计学意义（P〈0.05）;右美托咪啶组停药后均可立即唤醒,唤醒所需时间（30.0±9.8）min明显短于咪达唑仑组（80.0±6.7）min,差异有统计学意义（P〈0.05）;右美托咪啶组患者机械通气时间（5.16±1.68）h与咪达唑仑组（5.21±1.56）h比较,差异无统计学意义（P〉0.05）;谵妄发生率右美托咪啶组为54.0%较咪达唑仑组76.6%明显降低（P〈0.05）。结论：与咪达唑仑相比,右美托咪啶用于危重症患者镇静满意度更高、唤醒时间更短、谵妄发生率更低。

Objective： To compare the efficacy dexmedetomidine and midazolam for sedation in critically ill patients.Methods： Sixty patients admitted to the intensive care unit（ICU） of our hospital from October 2010 to February 2011 that were in need of sedation and analgesia were randomly divided into dexmedetomidine group（n=30） and midazolam group（n=30）.Patients in dexmedetomidine group were given a loading dose of dexmedetomidine（1 μg/kg） for 10 minutes and then maintained with 0.2~0.7μg·kg-1·h-1.Patients in midazolam group were given a loading dose of midazolam（0.05 mg/kg） for 1 minute and then maintained with 0.02~0.1μg·kg-1·h-1.Satisfactory about sedation level,length of mechanical ventilation,time to restore consciousness after the termination of drug use,incidence of delirium,were compared between the two groups.Results： The satisfactory about sedation level in dexmedetomidine group（83.3%） was higher than that in midazolam group（33.3%）（P0.05） when intake dose was adjusted to maintain the Ramsay score of 2-4.The patient in dexmedetomidine group could restore consciousness shortly after the termination of drug use,with an average time of（30.0±9.8） min,significant shorter than（80.0±6.7） min in midazolam group（P0.05）.There was no significant difference in length of mechanical ventilation between dexmedetomidine group and midazolam group[（5.16±1.68）hours vs（5.21±1.56） hours ]（P0.05）.The incidence of delirium in dexmedetomidine group（54%）was evidently lower than that in midazolam group（76.6%）（P0.05）.Conclusions： Comparing with midazolam,dexmedetomidine shows higher satisfactory sedation level,shorter awakening time,lower incidence of delirium.