咪达唑仑与丙泊酚用于老年体外循环心脏术后机械通气患者的临床研究

Clinical trial of midazolam and propofol in the treatment of elderly patients undergoing mechanical ventilation after cardiopulmonary bypass cardiac surgery

目的分析咪达唑仑与丙泊酚用于老年体外循环(CPB)心脏术后机械通气患者对镇静效果及血气指标的影响。方法将老年CPB心脏术后机械通气患者按队列法分为咪达唑仑组(M组)、丙泊酚组(P组)和咪达唑仑与丙泊酚联合给药组(M-P组)。M组静脉注射0.05~0.10mg·kg^(-1)咪达唑仑进行镇静诱导,再通过微量泵持续静脉泵入0.05~0.15mg·kg^(-1)·h^(-1)咪达唑仑;P组静脉注射0.5~1.0mg·kg^(-l)丙泊酚进行镇静诱导,再通过微量泵持续静脉泵入0.5~2.0mg·kg^(-1)h^(-1)丙泊酚;M-P组首先静脉注射0.02~0.05mg·kg^(-l)咪达唑仑及0.2~0.5mg·kg^(-l)丙泊酚进行镇静诱导,再继续持续静脉泵入0.05~0.1 mg·kg^(-l)咪达唑仑及0.5~0.8mg·kg^(-l)·h^(-l)丙泊酚。比较3组患者的镇静效果、血气指标、血流动力学指标、拔管时间、重症监护病房(ICU)滞留时间及治疗费用,并记录镇静治疗期间的药物不良反应发生情况。结果M组、P组和M-P组分别有43例、44例和39例。M组、P组和M-P组的药物起效时间分别为(77.94±12.05)、(18.18±5.20)和(21.25±9.36)s,达到满意镇静效果时间分别为(42.57±11.41)、(22.63±8.17)和(23.98±10.25)min,停药后苏醒时间分别为(59.30±14.86)、(19.83±5.44)和(22.16±6.29)min,拔管时间分别为(1.61±0.20)、(1.45±0.22)和(1.37±0.15)d,ICU滞留时间分别为(2.17±0.29)、(1.91±0.36)和(1.84±0.25)d,治疗费用分别为(186.59±60.83)、(922.97±164.34)和(375.03±71.16)千元,药物不良反应总发生率分别为34.88%、4.55%和7.69%,在统计学上差异均有统计学意义(均P<0.05);3组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)各时间点平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))比较,在统计学上差异均无统计学意义(均P>0.05)。结论咪达唑仑与丙泊酚联合给药用于老年CPB心脏术后机械通气患者具有显著的镇静效果,有利于减少镇静药物用量,且对患者血气指标及血流动力学指标的影响较小,较单一使用咪达唑仑有利于缩短拔管时间和ICU滞留时间,并降低药物不良反应总发生率,而较单一使用丙泊酚有利于减少治疗费用,是一种更加理想的镇静给药模式。

Objective To analyze the influence of midazolam and propofol on sedation effect and blood gas indicators in elderly patients undergoing mechanical ventilation after cardiopulmonary bypass(CPB)cardiac surgery.I Methods The elderly patients with mechanical ventilation after CPB cardiac surgery were grouped according to cohort method,including midazolam group(group M),propofol group(group P)and midazolam-propofol combined administration group(group M-P).Group M was treated with midazolam(intravenous injection of 0.05-0.10 mg·kg^(-1)midazolam for sedation induction,and then continuously intravenous injection of 0.05-0.15 mg·kg^(-1)·h^(-1)midazolam by micropump),and group P was treated with propofol(intravenous injection of O.5 mg kg^(-1)propofol for sedation induction,and then continuously intravenous injection of 0.5-2.0 mg·kg^(-1)·h^(-1)propofol by micropump),and group M-P was given combined administration of midazolam and propofol(intravenous injection of 0.02-0.05 mg·kg^(-1)midazolam and 0.2-0.5 mg·kg^(-1)propofol for sedation induction and then continuously intravenous pump of 0.05-0.1 mg·kg^(-1)midazolam and 0.5-0.8 mg·kg^(-1)·h^(-1)propofol).The sedation effect,blood gas indicators,hemodynamic indicators,extubation time,intensive care unit(ICU)stay time and treatment cost were compared among the three groups,and the adverse drug reactions during sedation therapy were recorded.Results There were 43 cases in group M,44 cases in group P,39 cases in group M-P.The drug onset times in groups M,P and M-P were(77.94±12.05),(18.18±5.20)and(21.25±9.36)s;the times to achieve satisfactory sedation effect were(42.57±11.41),(22.63±8.17)and(23.98±10.25)min;the recovery times after withdrawal were(59.30±14.86),(19.83±5.44)and(22.16±6.29)min;the extubation times were(1.61±0.20),(1.45±0.22)and(1.37±0.15)d;the ICU stay times were(2.17±0.29),(1.91±0.36)and(1.84±0.25)d;the treatment costs were(186.59±60.83),(922.97±164.34)and(375.03±71.16)thousand yuan;and the total incidence rates of adverse drug reactions were 34.88%,4.55%and 7.69%respectively,all with significant difference(all P<0.05).There were no statistically significant differences in mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_(2)),partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))at T_(o),T_(1),T_(2),T_(3),and T_(4) among the three groups(all P>0.05).Conclusion Combined administration of midazolam and propofol in elderly patients underwent mechanical ventilation after CPB cardiac surgery has a significant sedation effect,and it is conducive to reducing the dosages of sedative drugs,and it has small impact on blood gas indicators and hemodynamic indicators of patients.Compared with midazolam alone,it is more beneficial to shortening the extubation time and ICU stay and reducing the total incidence rate of adverse drug reactions,and compared with propofol alone,it is more beneficial to reducing treatment cost,and is a more ideal sedation administration model.