右美托咪定与咪达唑仑镇静在机械通气患者中的应用

Comparison of the sedation of dexmedetomidine versus midazolam on mechanically ventilated patients

目的观察右美托咪定与咪达唑仑在机械通气患者中的应用。方法将2014年5月至2015年1月我院ICU病房收治的76例需要有创机械通气及持续镇静治疗的患者,按照随机数字表法均分为咪达唑仑组（M组）和右美托咪定组（D组）。M组：咪达唑仑负荷量0.06 mg/kg静注,维持量0.04-0.2mg·kg-1·h-1;D组,右美托咪定负荷量1μg/kg静注10min,维持量0.2-0.7μg·kg-1·h-1。根据Ramsay镇静评分调整药物用量,使Ramsay镇静评分维持在2-4分。记录两组患者用药后达到Ramsay镇静评分2-4分的时间、Ramsay镇静评分、ICU住院时间、机械通气时间、唤醒时间。同时采用酶联免疫吸附法（ELISA）检测两组患者用药前、用药后24、48h血清肿瘤坏死因子α（TNF-α）、白细胞介素-6（IL-6）、高敏C反应蛋白（hs-CRP）水平的变化。结果 D组患者的ICU住院时间和唤醒时间明显短于M组（P〈0.05）。用药后24hD组患者血清TNF-α、hs-CRP水平明显低于M组（P〈0.05）,两组血清IL-6水平差异无统计学意义;用药后48hD组血清hsCRP水平明显低于M组（P〈0.05）,两组患者血清TNF-α、IL-6水平差异无统计学意义。结论有创性机械通气患者使用右美托咪定镇静,缩短患者ICU住院时间,且能有效降低患者体内炎症因子水平。

Objective To investigate sedation of dexmedetomidine versus midazolam on mechanically ventilated patients.Methods Seventy-six mechanically ventilated patients were randomly divided into midazolam group（group M）and dexmedetomidine group（group D）.The loading dose and maintenance dose of midazolam was 0.06mg/kg and 0.04-0.2mg·kg-1·h-1,and 1μg/kg and0.2-0.7μg·kg-1·h-1 for dexmedetomidine.The drug dose was adjusted according to Ramsay score scale.Time when Ramsay reach 2-4score,the length of ICU stay,mechanical ventilation time,drug adverse reactions,the levels of inflammation factors were recorded and compared between two groups.Results The length of ICU stay and arousing time in group D was significantly lower than that of group M（P〈0.05）.The levels of TNF-α,hs-CRP in group D were lower after 24 hr treatment than that of group M（P〈0.05）.The levels of hs-CRP in group D were lower after 48 hr treatment than that of group M（P〈0.01）.Conclusion Dexmedetomidine treatment reduced the lengh of ICU stay and levels of inflammatory factors of mechanical ventilated patients.