咪达唑仑为基础的短期镇静方案在ICU患者中的应用观察

THE EFFICACY OF SEDATIVE MIDAZOLAM BASED ON SHORT-TERM PROGRAM IN ICU PATIENTS

目的观察咪达唑仑在ICU患者中镇静的临床效果。方法将2011年7月)—2012年10月我院收治50例ICU患者按照基础疾病分为内科组、外科组,分别给予咪达唑仑为基础的短期镇静方案(<48h),定时唤醒。内科组先给予小剂量的负荷量咪达唑仑(0.04～0.2mg/kg)静脉推注,微量泵静脉持续泵入维持量咪达唑仑(0.03～0.30mg/(kg.h)[1],外科组患者同时联合芬太尼0.1μg/(kg.h),根据患者反应,每2h动态调节维持剂量直至达到理想的镇静深度,获得3～4级Ramsay镇静评分,观察各项镇静指标,并记录SpO2、血气分析、停药清醒时间、药物使用剂量和不良反应。结果二组患者均表现心率、血压、呼吸稳定,SpO2、血气结果都有改善,镇静效果满意。结论咪达唑仑适用于ICU中各种患者的镇静,短期(<48h)安全性高。但是对于老年患者的循环可能会产生影响,需要根据个体制定计划镇静方案。

Objective To observe the efficacy of midazolam sedation in ICU patients. Methods Total 50 ICU patients admitted to author＇s hospital in accordance with the underlying disease were divided into inter- nal medicine group, the surgical group from Jul. 2011 to Oct. 2012. All subjects were given the sedative midazolam based on short- term programs （less than 48 hours）, regular wake- up. The patients in medi- cine group were first load given small doses of midazolam （0.04-0.2mg/kg） intravenous injection and the micro pumps vein continuous infusion of the maintenance dose of midazolam [0.03-0.30mg/（kg· h）]. At the same time, surgical patients combined with fentanyl 0. lug/（kg·h）reaction according to the patients every two hours to dynamically adjust the maintenance dose until the desired depth of sedation, grade 3-4 Ramsay score. Then observed sedation indicators and recorded SpO2 , blood gas analysis, withdrawal sober time, dose of drug use and adverse events. Results All of patients showed improvements in heart rate, blood pressure, respiratory stability,SpO2, blood gas results and a satisfaction sedative effect. Conclusions Midazolam is applicable for sedation of various ICU patients and safe in short- term （〈48 hours）. Cycle system for elderly patients may have an impact, so it is necessary according to the individual plan sedation protocol.