咪达唑仑联合吗啡在重症急性左心衰竭机械通气中的镇静效果研究

Research on the Sedative Effects of Midazolam Combined with Morphine during Ventilation Treatment for Patients with Acute Severe Left Ventricular Failure

目的评价重症急性左心衰竭患者机械通气时采用咪达唑仑与吗啡联合持续镇静的效果。方法选择2007年4月-2010年4月在重症医学科(ICU)进行有创机械通气的重症急性左心衰竭患者86例,随机均分为咪达唑仑组(A组)、咪达唑仑联合吗啡组(B组)。采用Ramsay镇静评分,使每例患者镇静水平达RamsayⅢ～Ⅳ级。观察起效时间、镇静时间、停药后苏醒时间和停药后拔管时间;监测镇静12 h后的血气分析及血流动力学参数的变化。结果 B组起效时间、镇静时间、停药后苏醒时间和停药后拔管时间明显短于A组(P<0.05)。且镇静12 h后B组血气分析及血流动力学较A组明显改善(P<0.05)。结论重症急性左心衰竭患者机械通气时使用咪达唑仑联合吗啡镇静能达到满意镇静效果,同时改善重症急性左心衰竭患者的低氧血症和高碳酸血症。

Objective To investigate the sedative effect of midazolam combined with morphine during ventilation treatment for patients with acute severe left ventricular failure. Methods Eighty-six patients with acute severe left ventricular failure undergoing ventilation treatment in the Department oflCU in our hospital from April 2007 to April 2010 were randomly divided into midazolam （A） group and midazolam combined with morphine （B） group. Ramsay sedation level for every patient was adjusted to grade Ⅲ to Ⅳ. The onset time, sedation time, consciousness time and the time of extubation after medicine cessation were observed. Furthermore, we monitored the change of parameters of blood gas analysis and hemodynamics 12 hours after the treatment. Results The onset time, sedation time, consciousness time and the time of extubation after medicine cessation in group B were all significantly shorter than those in group A （P 〈 0.05）. Twelve hours after the treatment, the blood gas analysis and hemodynamics in group B were also much more improved than those in group A （P 〈 0.05）. Conclusion Midazolam combined with morphine used in ventilation treatment for patients with acute severe left ventricular failure has obvious sedative effect and is an effective procedure in correcting hypoxemia and hypercarbia.