咪达唑仑在体外循环心脏手术后的镇静疗效观察

Midazolam after Cardiac Surgery in Cardiopulmonary Bypass Efficacy of Sedation

目的：观察咪达唑仑对体外循环心脏手术后患者的镇静效果。方法：选取我院ICU科于2010年10月至2011年8月收治体外循环心脏手术后进行机械通气的患者30例,其麻醉清醒后即予咪达唑仑0.1mg/kg负荷量静脉推注,然后0.05~0.15mg/kg.h微泵静脉注射维持,以获得Ramsay评分2~5级,同时监测用药前和用药后30min、1h、3h、6h、12h、24h持续镇静时心率（HR）、有创动脉血压（BP）、中心静脉压（CVP）、呼吸（RR）、脉搏血氧饱和度（SPO2）、潮气量（VT）、气道峰压（PIP）、平均气道压（Pmean）、氧合指数（PaO2/FiO2）的变化。结果：30例患者在负荷剂量下均能达到镇静要求,Ramsay评分≥2级,维持剂量也能够保持平稳满意的镇静效果,均有顺行性遗忘效应,且能有效减少人机对抗,对循环影响轻微,无明显的呼吸抑制。结论：咪达唑仑可作为体外循环心脏手术后患者的理想镇静药物。

Objective： Observation of midazolam after cardiac surgery with cardiopulmonary bypass in patients with sedation.Methods： Select the ICU of our hospital department in October 2010 to August 2011 were treated after cardiopulmonary bypass in 30 patients with mechanical ventilation,After the verdict,its awake anesthesia midazolam 0.1mg/kg loading dose intravenous injection,And 0.05 ~ 0.15mg/kg h intravenously to maintain micro-pump to get the Ramsay score 2 to 5,while monitoring before treatment and after treatment 30min,1h,3h,6h,12h,24h continuous sedation,heart rate（HR）,invasive arterial blood pressure（BP）,central venous pressure（CVP）,respiratory（RR）,pulse oxygen saturation（SPO2）,tidal volume（VT）,peak airway pressure（PIP）,mean airway pressure（Pmean）,oxygenation index（PaO2 / FiO2） changes.Results： 30 patients in the loading dose can reach the sedative requirements,Ramsay score ≥ 2 level,but also to maintain a stable maintenance dose of the sedative effects of satisfaction,both anterograde amnesia effect,and can effectively reduce the man-machine confrontation,impact on cycle mild,no significant respiratory depression.Conclusion： Midazolam as a patient after cardiopulmonary bypass ideal sedative drugs.