冠脉旁路移植术后患者的异丙酚镇静效果评价

Assessment of the Sedative Effect of Propofol after Coronary Artery Bypass Graft Surgery

目的 对比异丙酚和咪达唑仑对重症监护室（intensive care unit,ICU）内冠状动脉旁路移植术（coronary artery bypass graft,CABG）后患者的镇静效果.方法 50名CABG术后进入ICU,并需要气管插管的患者被随机分为两组,分别接受异丙酚和咪达唑仑镇静.两组患者按需要使用芬太尼镇痛.患者的纳入标准包括：年龄40～ 60岁、血流动力学稳定、射血分数大于40％.主要观察指标为镇静深度,由Ramsay镇静评分（Ramsay sedation score,RSS）表示.其余指标包括气管拔管前连续监测得到的有创平均动脉压、心率、动脉血气和呼吸机通气参数.结果 异丙酚组和咪达唑仑组的镇静深度大致相同（RSS=4.5 vsRSS=4.7,P=0.295）,但是咪达唑仑组的芬太尼使用量明显大于异丙酚组（12.5mg/h vs 4mg/h,P=0.004）.两组间平均动脉压（P=0.510）和心率（P =0.410）差异无统计学意义.异丙酚组患者的平均拔管时间短于咪达唑仑组患者（102±27min vs 245±42min,P=0.019）,但两组间ICU住院时间比较差异无统计学意义（47.5h vs 36.3h,P=0.240）.结论 异丙酚能为CABG术后患者提供较为理想的镇静,能够明显减少镇痛药的需求量,并缩短气管插管时间.

Objective To compare the sedation of propofol to midazolam after coronary artery bypass graft （CABG） surgery in the intensive care unit （ ICU）. Methods Fifty patients who were admitted to the ICU after CABG surgery was randomized into two groups to receive either midazolam sedation or propofol sedation, and fentanyl analgesia was administered if required. Inclusion criteria were as fol- lows： 40 -60 years old, hemodynamic stability, ejection fraction 〉 40%. Depth of sedation was the main object and monitored using the Ramsay sedation score （RSS）. Invasive mean arterial pressure and heart rate, arterial blood gas and ventilatory parameters were moni- tored continuously after the start of study drug and until the patients were extubated. Results The depth of sedation was almost the same in the two groups （ RSS = 4.5 in midazolam group vs 4.7 in propofol group,P = O. 259） but the total dose of fentanyl in the midazolam group was significantly more than the propofol group （12.5mg/h vs 4mg/h） （P = 0. 004）. No significant differences were found in MAP （P = 0. 510） and HR （P = 0. 410） between the groups. The mean extubation time in patients sedated with propofol was shorter than those sedated with midazolam （102 ± 27min vs 245 ± 42rain, respectively, P 〈 0.05） but the ICU discharge time was not shorter （47.5h vs 36.3h, respectively,P = 0. 24）. Conclusion Propofol provided a acceptable sedation for post - CABG surgical patients, significantly re- duced the requirement for analgesics, and allowed for more rapid tracheal extubation.