天王补心丹对慢性阻塞性肺疾病机械通气患者镇静作用的研究

Clinical observation on sedative effect of Tianwang-Buxin Dan for chronic obstructive pulmonary disease patients undergoing mechanical ventilation

目的 观察天王补心丹对慢性阻塞性肺疾病机械通气患者的镇静作用.方法 收集2009年1月至2013年1月自贡市中医医院重症医学科慢性阻塞性肺疾病机械通气患者97例,采用随机数字表法将患者随机分为治疗组47例和对照组50例.对照组采用咪达唑仑、芬太尼镇静、镇痛等常规疗法治疗,治疗组在对照组治疗基础上加用天王补心丹.观察并比较两组治疗期间镇静镇痛药物用量,机械通气（MV）时间,以及低血压、心动过缓、谵妄、恶心等副作用发生率.结果 两组均能使患者达到镇静及镇痛目标评分,治疗组更易唤醒及保持安静.与对照组比较,治疗组咪达唑仑用量[（9.51±5.87）、（20.01±6.24）] μg/kg·h-1,及芬太尼用量[（0.22±0.13）、（0.32±0.12）] μg/kg·h-1均明显减少（P＜0.01或0.05）;机械通气（MV）时间[（7.13±6.25）d、（12.85±9.13）d],及停用镇静剂后拔管时间[（4.35±2.57）h、（8.79±4.02） h]均明显缩短（P＜0.01）;低血压发生率、心动过缓发生率、谵妄发生率及恶心发生率均明显降低（x2=12.34、6.321、10.657、12.34,P＜ 0.05）.结论 天王补心丹对慢性阻塞性疾病机械通气患者镇静效果满意,易唤醒,谵妄发生率低,可缩短MV时间、停用镇静剂后拔管时间,减少咪达唑仑用量约50％,减少芬太尼用量约30％.

Objective To observe the clinical sedativelefficacy of Tianwang-Buxin Dan treating chronic obstructive pulmonary disease patients undergoing mechanical ventilation.Methods 97 patients with chronic obstructive pulmonary disease undergoing mechanical ventilation were randomly recruited into a treatment group （47 cases） and a control group （50 cases）.The control group was treated with midazolam and fentanyl,and the treatment group were treated by Tianwang-Buxin Dan on the basis of the control group.The amount of medazolam and fentanyl,duration of MV,and incidence of side-effects such as hypotension,bradycardia,delirium,nausea,etc were observed in both groups.Results The expected sedative and analgesia scores were obtained in patients of both groups.Compared with the control group,the patients in the treatment group were easier to be aroused and be kept in sedation and analgesia state,besides the dose of midazolam （μg/kg·h-1） （9.51 ±5.87 vs 20.01 ±6.24,P〈0.01）and fentanyl （μg/kg·h-1） was significantly fewer （0.22 ±0.13 vs 0.32±0.12,P〈0.05）,duration of MV （days） was shorter（7.13±6.25 vs 12.85±9.13,P〈0.01）,duration of disable sedatives for extubating （hours）was shorter （4.35 ± 2.57 vs 8.79±4.02,P〈0.01）,the rates of hypotensionand brdycarcardia were significantly lower,the rates of delirium and nausea were clearly lower（both P〈0.05）in the treatment group.Conclusion Sedative effect of Tianwang-Buxin Dan is satisfactory for patients with chronic obstructive pulmonary disease undergoing mechanical ventilation,with the property of easier arousal,lower hypotension rates,lower brdycarcardia rates,lower delirium rates nausea rates,and fewer dosage of midazolam （by 50%） and fentanyl （by 30%） administration.