右美托咪定与咪达唑仑用于重症监护病房连枷胸并肺损伤患者镇静的效果比较

The Sedation Effect Comparison of Dexmedetomidine and Midazolam To Treat Patients with Flail Chest Complicated with Pulmonary Injury in ICU

目的探讨右美托咪定与咪达唑仑对连枷胸并肺损伤患者的临床效果。方法连枷胸并肺损伤需要行机械通气的患者36例,随机将患者分为右美托咪定组18例和咪达唑仑组18例。右美托咪定组:给予右美托咪定负荷量1μg/(kg.h)经静脉泵注射20 min,维持剂量0.2μg^0.7μg/(kg.h)持,咪达唑仑组:负荷量(0.01-0.3)mg/kg咪达唑仑进行镇静诱导,维持量(0.03~0.3)mg/(kg.h)。比较两组患者的心率、血压、芬太尼用量、脱机时间,住重症监护病房(ICU)时间等。结果右美托咪定组在机械通气6、24 h的心率减慢(P值均<0.05),而在48 h的心率的差异均无显著性(P值均>0.05)。右美托咪定组的芬太尼使用量显著减少(P<0.05),机械通气时间、住ICU时间缩短(P<0.05)。结论右美托咪定应用于连枷胸并肺损伤患者镇静安全、有效,能减少降压药物及芬太尼的用量,并能减少机械通气时间,缩短住ICU时间。

Objective To Explore the clinical efficacy of dexmedetomidine and midazolam for sedation of flail chest complicated with acute pulmonary contusion patients in intensive care unit. Methods Select thirty-six flail chest complicated with acute pup monary contusion patients treated by ventilatory support; they were randomly divided into two groups to receive either dexmedetomidine or midazolam The dexmedetomidine group （Group A,n= 18） received a loading dose of 1g.kg-1 .h-1 for 20 min, followed by continuous infusion at 0.2-0.7g. kg-1. h-1. The midazolam group （Group B,n=18） received a loading dose of 0.01-0.3mg/kg, followed by continuous infusion at 0.03-0.3 mg. kg-1. h-1.The heart rate. Mechanical ventilation time, blood pressure, fentanyl dosage, duration in ICU were compared between the 2 groups. Results Compared with Group B, the heart rate in Group A was significantly slower within 24h （P〈0.05）, and the heart rates were similar between the 2 groups during 48h （P〉0.05）. Moreover, the Mechanical ventilation time and the demand for fentanyl, duration of ICU stay were less in Group A compared with those in Group B （P〈 0.05）. Conclusion Dexmedetomidine is safe and effective for the sedation of flail chest complicated with acute pulmonary contusion patients, which can reduce the demand for fentanyl, the Mechanical ventilation time and the duration of ICU stay.