咪达唑仑-丙泊酚序贯给药在机械通气患者程序化镇静中的应用

Clinical application of Midazolam-Propofol sequential administration in the sequencing sedation of mechanical ventilation

目的研究对机械通气患者程序化镇静过程中使用咪达唑仑-丙泊酚序贯给药的应用效果。方法选取2015年1月~2016年2月我院重症医学科接收的危重疾病需接受机械通气治疗患者80例,所有患者经医生评估预计需接受机械通气>72 h,按照用药方式将患者划分为三组,分别为P组(使用丙泊酚)26例、M组(使用咪达唑仑)26例、M-P组(使用咪达唑仑联合丙泊酚)28例,评估三组患者镇静期间各项指标结果。结果 P组患者治疗花费为(4002.35±741.01)元,明显高于M组[(852.32±43.21)元]及M-P组[(902.36±54.32)元](P=0.000)。M组患者停药后清醒用时为(7.20±1.00)h,明显高于P组[(0.79±0.52)h]和M-P组[(1.00±0.25)h](P=0.000)。M组患者再躁动发生率,高于P组、M-P组(χ~2=4.722,P=0.094)。P组患者丙泊酚药物用量为(7882.24±1001.50)mg,明显高于M-P组[(1153.50±105.30)mg](t=35.371,P=0.000);M-P组咪达唑仑药物总用量为(310.23±51.06)mg,明显低于M组[(428.23±70.55)mg](t=7.078,P=0.000)。镇静前、镇静后1 h、镇静期间,P组患者MAP、HR均未见明显变化(P>0.05),M组MAP、HR波动较为明显(P<0.05),而M-P组MAP、HR于各时间点较为平稳(P>0.05)。镇静前、镇静后1 h、镇静期间,三组患者的SpO_2均逐渐升高(P<0.05)。结论对ICU机械通气患者程序化镇静过程中使用咪达唑仑-丙泊酚序贯给药,联合用药可减少单独用药量,减少治疗花费、且药量降低可减少患者躁动发生率,同时联合用药可保证镇静效果。

Objective To study the clinical application of Midazolam and Propofol sequential administration during the sequencing sedation of mechanical ventilation.Methods 80 patients from January 2015 to February 2016 in the ICU of our hospital were selected.According to the doctors＇ evaluations,all the patients were received the mechanical ventilation for 〉72 h or more.The subjects were divided into group P （26 cases）,group M （26 cases）and group M-P （28 cases） according to the different administration methods.Group P took Propofol;group M took Midazolam;group M-P took the combined therapy of Midazolam and Propofol.During the process,the related index for three groups was compared.Results The hospitalization cost for group P [（4002.35±741.01） yuan] was significantly higher than group M [（852.32±43.21） yuan] and group M-P [（902.36±54.32） yuan] （P=0.000）.The awakening time for group M [（7.20±1.00） h] was significantly longer than group P [（0.79±0.52） hi and group M-P [（1.00±0.25） hi （P=0.000）.The incidence rate of repeated dysphoria for group M was higher than group P and group M-P （X2=4.722,P=0.094）.The dosage of Propofol for group P [（7882.24±1001.50） mg] was significantly higher than group M-P [（1153.50±105.30） mg] （t=35.371,P=0.000）.The overall dosage of Midazolam for group M-P [（310.23±51.06） mg] was lower than group M [（428.23±70.55） mg] （t=7.078,P=0.000）.Before sedation,after 1 h of sedation,during the sedation,levels of MAP, HR of the group P had no significant change （P〉0.05）,while had significant change in the group M （P〈0.05）,both MAP and HR had no significant change in the group M-P in each time point （P〉0.05）.Before sedation,after 1 h of sedation,during the sedation,the SpO2 of patients in the three groups of was in creased gradually （P〈0.05）.Conelusion During the sequencing sedation of mechanical ventilation,the Midazolam and Propofol sequential administration has an obvious effect in ICU patients,can reduce the dosage of the single sedation drugs, hospitalization costs,overall dosage and incidence rate of dysphoria.Meanwhile,the combined therapy can improve the sedation effect.