丙泊酚与咪达唑仑在重症肺炎患者有创机械通气中的镇静效果比较

Comparison of the sedative effects between propofol and midazolam in invasive mechanical ventilation of patients with severe pneumonia

目的比较丙泊酚与咪达唑仑在重症肺炎患者有创机械通气中的镇静效果。方法选取2016年9月-2019年9月四川省德阳市人民医院重症医学科行有创机械通气治疗重症肺炎患者130例。按照摸球法随机分为丙泊酚组与咪达唑仑组,每组65例,有创机械通气治疗中分别予丙泊酚和咪达唑仑镇静。比较2组用药前、用药24 h后血氧饱和度(SpO2)、平均动脉压(MAP)和心率(HR);比较2组用药前、用药后72 h白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平;比较2组达到理想镇静时间、机械通气时间及拔管时间。结果用药24 h后,2组SpO2水平高于用药前(P<0.05),MAP与HR均低于用药前(P<0.05),且丙泊酚组MAP与HR低于咪达唑仑组(P<0.01);用药72 h后,2组IL-6、IL-10、TNF-α水平低于用药前,且丙泊酚组低于咪达唑仑组(P<0.05);丙泊酚组达到理想镇静时间与机械通气时间均短于咪达唑仑组(P<0.01),拔管时间早于咪达唑仑组(P<0.05)。结论丙泊酚与咪达唑仑在重症肺炎患者有创机械通气治疗中均有显著镇静效果,但丙泊酚显著优于咪达唑仑。

Objective To compare the sedative effects between propofol and midazolam in invasive mechanical ventilation of patients with severe pneumonia. Methods 130 patients with severe pneumonia treated with invasive mechanical ventilation who were admitted to the Department of Intensive Medicine in People’s Hospital of Deyang City from September 2016 to September 2019 were selected,and they were divided into propofol group(n = 65) and midazolam group(n = 65) according to the method of touching the ball,during the treatment of invasive mechanical ventilation,propofol and midazolam were given to the two groups respectively. The SpO2,MAP and HR of the two groups before and 24 hours after the treatment were compared;The levels of IL-6,IL-10 and TNF-α of the two groups were compared before and 72 hours after treatment;The ideal sedation time,mechanical ventilation time and extubation time of the two groups were compared. Results After 24 hours of treatment,SpO2 levels in the two groups were higher than before treatment(P< 0. 05),MAP and HR were lower than before treatment(P< 0. 05),MAP and HR in the propofol group were lower than those of midazolam group(P< 0. 01);After 72 hours of treatment,the levels of IL-6,IL-10 and TNF-α in the two groups were lower than before the treatment,and the propofol group was lower than the midazolam group(P< 0. 05);The time to ideal sedation and mechanical ventilation in the propofol group were significantly shorter than those in the midazolam group(P< 0. 01),and the time of extubation was earlier than that in the midazolam group(P< 0. 05). Conclusion Propofol and midazolam have significant sedative effects in the treatment of severe pneumonia patients with invasive mechanical ventilation,but propofol is significantly better than midazolam.