右美托咪定与咪达唑仑对中度颅脑损伤患者的镇静效果对比研究

Study on the comparison of sedation effect between dexmedetomidine and midazolam in patients with moderate craniocerebral injury

目的探讨右美托咪定、咪达唑仑对于中度颅脑损伤患者的镇静效果及临床预后的影响。方法选取2017年1月至2018年6月该科收治的中度颅脑损伤患者60例作为研究对象,随机分为观察组和对照组,每组30例。观察组采用右美托咪定0.2~0.7μg/(kg·min)持续泵入,对照组采用咪达唑仑0.3~0.5mg/(kg·min)持续泵入,根据RASS镇静评分调整药物剂量。记录二组患者性别、年龄、体重、心率、血氧饱和度、不良反应、重症监护病房(ICU)住院时间、出院6个月后预后情况等并进行统计分析。结果使用镇静药物后,两组患者心率较用药前均有所下降,对照组下降更明显,对照组患者血氧饱和度较用药前有下降,差异均有统计学意义(P<0.05)。观察组患者心动过缓、肺部感染、谵妄发生率明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者ICU住院时间及总住院时间明显低于对照组,差异均有统计学意义(P<0.05)。两组患者的近期预后比较,差异无统计学意义(P>0.05)。结论右美托咪定与咪达唑仑镇静效果均较良好,但右美托咪定对患者呼吸及循环系统影响小于咪达唑仑。且右美托咪定能抑制炎性反应,缩短住院时间,适用于中度颅脑损伤患者的镇静治疗。

Objective To investigate the sedation effect and clinical prognosis of dexmedetomidine and midazolam in patients with moderate craniocerebral injury.Methods 60 patients with moderate craniocerebral injury admitted to the department from January 2017 to June 2018 were selected as research objects and randomly divided into observation group and control group,with 30 patients in each group.The observation group was continuously pumped with dexmedetomidine 0.2-0.7μg/(kg min),while the control group was continuously pumped with midazolam 0.3-0.5 mg/(kg min),and the dose was adjusted according to RASS sedation score.Gender,age,weight,heart rate,blood oxygen saturation,adverse reactions,length of stay in intensive care unit(ICU),prognosis of 6 months after discharge of patients in the two groups were recorded and statistically analyzed.Results After the use of sedative drugs,the heart rate of patients in the two groups decreased compared with that before the use of drugs,and the decrease was more obvious in the control group,while the blood oxygen saturation of patients in the control group decreased compared with that before the use of drugs,and the differences were statistically significant(P<0.05).In the observation group,the incidence of bradycardia,pulmonary infection and delirium were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The length of stay in ICU and total length of stay in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).There was no significant difference in the short-term prognosis between the two groups(P>0.05).Conclusion Both dexmedetomidine and midazolam have good sedative effects,but the effect of dexmedetomidine on the respiratory and circulatory systems of patients is less than that of midazolam.Moreover,dexmedetomidine can inhibit the inflammatory response and shorten the hospitalization time,so it is suitable for the sedative treatment of patients with moderate craniocerebral brain injury.