丙泊酚与右美托咪定对机械通气患者镇静效果的比较研究

Comparison of Sedative Effects of Propofol and Dexmedetomidine on Mechanical Ventilation

目的:探讨丙泊酚与右美托咪定对机械通气患者的镇静效果。方法:回顾性分析2012年7月-2017年7月在本院重症医学科住院且行机械通气治疗需要镇静的100例患者的临床资料。根据镇静剂的不同分为丙泊酚组(50例)、右美托咪定组(50例)。两组患者分别给予负荷量,之后微量注射泵泵入,采用Ramsay镇静评分,镇静深度2～4级,每2小时评估1次。观察各组患者镇静用药前后生命体征及潮气量变化,记录镇静剂的应用时间及机械通气的应用时间。结果:两组患者用药2 h后的收缩压(SBP)、舒张压(DBP)、心率(HR)、潮气量(VT)均较用药前显著降低(P<0.05);但用药2 h后两组上述指标比较,差异均无统计学意义(P>0.05);右美托咪定组用药前后的呼吸频率(RR)比较,差异无统计学意义(P>0.05);丙泊酚组用药2 h后的RR明显低于用药前,差异有统计学意义(P<0.05)。用药2 h后,两组动脉血氧分压(PaO2)、RR比较,差异均有统计学意义(P<0.05)。右美托咪定组的镇静剂持续应用时间、机械通气时间均短于丙泊酚组,差异均有统计学意义(P<0.05)。结论:丙泊酚和右美托咪定应用于机械通气患者,均可有效镇静,提高PaO2。两种镇静剂对呼吸、循环都有影响,但是右美托咪定对呼吸影响小,对循环的抑制同丙泊酚比较无差异,且能明显提高动脉血氧分压,缩短镇静剂持续应用时间和机械通气时间。

Objective:To investigate the sedative effect of Propofol and Dexmedetomidine on patients with mechanical ventilation.Method:The clinical data of 100 patients admitted to the ICU department of our hospital from July 2012 to July 2017 who were treated with mechanical ventilation and required sedation were retrospectively analyzed.Patients were divided into Propofol group(50 cases)and Dexmedetomidine group(50 cases)according to different sedatives.Patients in the two groups were given loads respectively and then pumped into the microsyringe pump,Ramsay sedation score was used,sedation depth was 2-4 grade,and the sedation was evaluated every 2 hours.The changes of vital signs and tidal volume before and after analgesics were observed,the application time of analgesics and mechanical ventilation were recorded.Result:After 2 h of treatment,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and tidal volume(VT)of patients in the two groups were significantly reduced(P<0.05);however,after 2 h of treatment,there were no significant differences in the above indicators between the two groups(P >0.05);there was no significant difference in respiratory rate(RR)between the Dexmedetomidine group before and after treatment(P >0.05);the RR of Propofol group after 2 h was significantly lower than that before treatment,the difference was statistically significant(P<0.05).After 2 h of treatment,the arterial partial oxygen pressure(PaO2)and RR of the two groups were compared,the differences were statistically significant(P<0.05).The duration of sedative use and mechanical ventilation time in the Dexmedetomidine group was shorter than that in the Propofol group,the differences were statistically significant(P<0.05).Conclusion:Propofol and Dexmedetomidine applied in the patients with mechanical ventilation,can effective sedation,increase PaO2.Two depressants have influence on respiratory cycle,however,the Dexmedetomidine for breathing impact of small,compared with Propofol without the restraint of the circulation differences,and can significantly improve arterial blood oxygen partial pressure,shorten the depressant used mechanical ventilation time and duration.