瑞马唑仑在ICU机械通气老年患者中的镇静效果及对循环系统的影响

The sedative effect of remimazolam on ICU elderly patients undergoing mechanical ventilation and its influence on the circulatory system

目的探讨瑞马唑仑在ICU机械通气老年患者中的镇静效果及对循环系统的影响。方法采用前瞻性研究的方法,选择2021年10月至2023年6月河北中石油中心医院ICU行机械通气的老年患者189例,按随机数字表法分为瑞马唑仑组、右美托咪定组和丙泊酚组,每组63例。瑞马唑仑组、右美托咪定组、丙泊酚组分别给予瑞马唑仑、右美托咪定、丙泊酚进行镇静。比较三组患者镇静达标时间、镇静达标率、镇静维持时间和停药后苏醒时间。记录用药前(T_(0))、用药15 min(T_(1))、用药30 min(T_(2))、用药1 h(T_(3))、用药6 h(T_(4))和用药12 h(T_(5))心率、平均动脉压(MAP)、呼吸频率和脉搏血氧饱和度(SpO_(2))。记录三组镇静过程中心动过缓、低血压、呼吸抑制、体动和谵妄发生情况。结果瑞马唑仑组镇静达标时间和停药后苏醒时间明显短于右美托咪定组和丙泊酚组[(22.27±5.31)min比(29.45±6.24)和(30.12±5.87)min、(28.66±7.06)min比(32.22±6.85)和(34.34±7.24)min],差异有统计学意义(P<0.05);右美托咪定组与丙泊酚组比较差异无统计学意义(P>0.05)。瑞马唑仑组和右美托咪定组镇静达标率明显高于丙泊酚组[87.43%(661/756)和83.60%(632/756)比72.49%(548/756)],差异有统计学意义(P<0.0167);瑞马唑仑组与右美托咪定组比较差异无统计学意义(P>0.0167)。三组镇静维持时间比较差异无统计学意义(P>0.05)。三组T_(0)心率、MAP、呼吸频率和SpO_(2)比较差异无统计学意义(P>0.05)。瑞马唑仑组T_(1)~T_(5)心率和MAP明显高于右美托咪定组和丙泊酚组,右美托咪定组T_(2)~T_(5)心率和MAP明显低于丙泊酚组,差异有统计学意义(P<0.05)。瑞马唑仑组T_(2)~T_(5)呼吸频率明显低于右美托咪定组,瑞马唑仑组和右美托咪定组T_(1)~T_(5)呼吸频率明显高于丙泊酚组,差异有统计学意义(P<0.05)。瑞马唑仑组和右美托咪定组T_(2)~T_(5) SpO_(2)明显高于丙泊酚组,差异有统计学意义(P<0.05)。瑞马唑仑组心动过缓发生率明显低于右美托咪定组[7.94%(5/63)比25.40%(16/63)],低血压发生率明显低于丙泊酚组[6.35%(4/63)比23.81%(15/63)],差异有统计学意义(P<0.0167)。瑞马唑仑组和右美托咪定组呼吸抑制发生率明显低于丙泊酚组[4.76%(3/63)和1.59%(1/63)比22.22%(14/63)],差异有统计学意义(P<0.0167)。三组谵妄发生率比较差异有统计学意义(P<0.05),但两两比较差异无统计学意义(P>0.0167)。三组体动发生率比较差异无统计学意义(P>0.05)。结论ICU机械通气老年患者采用瑞马唑仑镇静的效果满意,用药过程中对循环和呼吸系统影响小,不良反应少。

ObjectiveTo investigate the sedative effect of remimazolam on ICU elderly patients undergoing mechanical ventilation and its influence on circulatory system.MethodsUsing a prospective research approach,189 ICU elderly patients undergoing mechanical ventilation in Hebei Petro China Central Hospital from October 2021 to June 2023 were selected.The patients were divided into remimazolam group,dexmedetomidine group and propofol group by random number table method with 63 cases in each group.The patients in remimazolam group,dexmedetomidine group and propofol group were sedated with remimazolam,dexmedetomidine and propofol,respectively.The sedation standard time,sedation standard rate,sedation maintenance time and recovery time after drug withdrawal were compared among the three groups.The heart rate,mean arterial pressure(MAP),respiratory rate and pulse oxygen saturation(SpO_(2))before medication(T_(0))and medication for 15 min(T_(1)),30 min(T_(2)),1 h(T_(3)),6 h(T_(4)),12 h(T_(5))were recorded.The incidences of bradycardia,hypotension,respiratory depression,body movement and delirium during sedation were recorded.ResultsThe sedation standard time and recovery time after drug withdrawal in remimazolam group were significantly shorter than those in dexmedetomidine group and propofol group:(22.27±5.31)min vs.(29.45±6.24)and(30.12±5.87)min,(28.66±7.06)min vs.(32.22±6.85)and(34.34±7.24)min,and there were statistical differences(P<0.05);there were no statistical difference between dexmedetomidine group and propofol group(P>0.05).The sedation standard rate in remimazolam group and dexmedetomidine group was significantly higher than that in propofol group:87.43%(661/756)and 83.60%(632/756)vs.72.49%(548/756),and there was statistical difference(P<0.0167);there was no statistical difference between remimazolam group and dexmedetomidine group(P>0.0167).There was no statistical difference in sedation maintenance time among the three groups(P>0.05).There were no statistical difference in T_(0) heart rate,MAP,respiratory rate and SpO_(2) among the three groups(P>0.05).The T_(1) to T_(5) heart rate and MAP in remimazolam group were significantly higher than those in dexmedetomidine group and propofol group,the T_(2) to T_(5) heart rate and MAP in dexmedetomidine group were significantly lower than those in propofol group,and there were statistical differences(P<0.05).The T_(2) to T_(5) respiratory rate in remimazolam group was significantly lower than that in dexmedetomidine group,the T_(1) to T_(5) respiratory rate in remimazolam group and dexmedetomidine group was significantly higher than that in propofol group,and there were statistical differences(P<0.05).The T_(2) to T_(5) SpO_(2) in remimazolam group and dexmedetomidine group was significantly higher than that in propofol group,and there was statistical difference(P<0.05).The incidence of bradycardia in remimazolam group was significantly lower than that in dexmedetomidine group:7.94%(5/63)vs.25.40%(16/63),the incidence of hypotension was significantly lower than that in propofol group:6.35%(4/63)vs.23.81%(15/63),and there were statistical differences(P<0.0167).The incidence of respiratory depression in remimazolam group and dexmedetomidine group was significantly lower than that in propofol group:4.76%(3/63)and 1.59%(1/63)vs.22.22%(14/63),and there was statistical difference(P<0.0167).There was statistical difference in incidence of delirium among the three groups(P<0.05),but there was no statistically significant difference in pairwise comparison(P>0.0167).There was no statistical difference in the incidence of body movement among the three groups(P>0.05).ConclusionsThe effect of remimazolam sedation in ICU elderly patients undergoing mechanical ventilation is satisfactory,with little influence on circulation and respiratory system and few adverse reactions.