利多卡因雾化吸入在重症加强治疗病房机械通气患者中的应用

Application of Lidocaine via Nebulization during Mechanical Ventilation in Intensive Care Unit

目的观察咪达唑仑静脉滴注复合利多卡因雾化吸入对重症加强治疗病房(ICU)机械通气患者气管导管耐受情况的影响。方法将60例胸科术后需行机械通气患者随机分为2组,治疗组患者给予咪达唑仑静脉滴注复合利多卡因雾化吸入,对照组患者给予咪达唑仑静脉滴注复合0.9%氯化钠注射液雾化吸入。2组患者根据Ramsay镇静以及呛咳评分追加咪达唑仑以及芬太尼用量。记录患者在机械通气期间的镇静评分、呛咳评分、平均动脉压(MAP)、心率(HR),记录咪达唑仑和芬太尼的给药次数、使用剂量。结果治疗组患者在机械通气期间呛咳反应、高血压和心动过速的发生次数显著低于对照组(P<0.05);治疗组患者在机械通气24 h内咪达唑仑和芬太尼的给药次数和使用剂量显著低于对照组(P<0.05)。结论咪达唑仑静脉滴注复合利多卡因雾化吸入可以显著减轻气管导管引起的不良反应,减少ICU患者的镇静药物用量。

Objective To evaluate the effects of midazolam intravenous drip combined with lidocaine via nebulization on patients during mechanical ventilation in intensive care unit （ICU）. Methods 60 thoracic patients required postoperative mechanical ventilation in ICU were randomized into 2 groups. The patients in therapeutic group received lidocaine 1 mg/kg via nebulization and midazolam intravenous drip 0. 1 mg .kg-1 . h-1. The patients in control group received 0.9% NaCl 1 mg/kg via nebulization and midazolam 0. 1 mg . kg-1 . h-1. According to the scale of Ramsay ,the additional midazolam and fentanyl were injected to maintain sedation and inhibit cough in both groups. During ventilation, calm score, the number and the severity of cough, the mean arterial pressure （MAP）, heart rate （HR）, and the consumption of midazolam and fentanyl were record. Results The number and severity of cough, the scale of MAP and HR in the therapeutic group were all significant lower than those in the control group （ P 〈 0.05 ）. The consumption of midazolam and fentanyl in the therapeutic group were also significantly lower than that in the control group （P 〈 0. 05 ）. Conclusion Midazolam intravenous drip combined with lidocaine via nebulization can reduce the side effects and requirement of sedative and opioids drug in ICU patients undergoing mechanical ventilation.