两种不同镇静镇痛方法在抢救性气管插管中的临床研究

Clinical Study of Two Different Methods of Sedation and Analgesia in the Emergency Tracheal Intubation

目的探讨两种不同诱导方法在抢救性气管插管中的安全性及有效性。方法将74例行抢救性气管插管的危重患者根据治疗适应证和家属意见分为两组各37例,异丙酚组给予异丙酚+芬太尼;咪达唑仑组给予咪达唑仑+芬太尼。观察两组患者插管前,插管时及插管后的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率-收缩压乘积(RPP),血氧饱和度(SpO2)及Ramsay评分情况。结果两组间比较,患者的血流动力学指标(SBP、DBP、HR、RPP)、SpO2和Ramsay评分均无统计学意义(P>0.05)。插管时及插管后两组患者的心率、血压和RPP均显著低于插管前(P<0.05);插管时两组患者的SpO2均显著低于插管前(P<0.05),插管后两组患者的SpO2均显著高于插管前(P<0.05);插管时和插管后两组Ramsay评分均显著高于插管前(P<0.05)。结论小剂量异丙酚或小剂量咪达唑仑并复合芬太尼可用于危重患者的紧急插管疗效相近,可减轻心血管反应、心肌耗氧及患者的痛苦,值得推广。

Objective To explore the safety and efficacy of 2 different methods of sedative and analgesic approaches in emergent endotracheal intubation.Methods 74 critically ill patients who were scheduled for endotracheal intubation were randomly divided into two groups（37 cases/group）according to the therapeutic indications and family opinions,propofol group（propofol＋fentanyl）,and midazolam group（midazolam＋fentanyl）.The SBP,DBP,HR,RPP,SpO2,and Ramsay score were monitored before,during and after intubation,respectively.Results All of the hemodynamic parameters（SBP,DBP,HR,RPP）,SpO2 and Ramsay scores in two groups had no significant differences（P0.05）.During and after intubation,HR,BP and RPP of patients were significantly lower than before intubation（P0.05）;during intubation,SpO2 of patients were significantly lower than before intubation（P0.05）;after intubation,SpO2 were significantly lower than before intubation（P0.05）.During and after intubation,Ramsay score significantly increased（P0.05）.Conclusion Small dose of propofol or midazolam with fentanyl are both safe and effective methods of sedation and analgesia in emergent endotracheal intubation,with similar therapeutic effect,which can relieve the cardiovascular response,myocardial oxygen consumption and the patient′s pain,thus is worthy of clinical promotion.