小剂量异丙酚用于老年机械通气患者镇静效果的临床观察

Clinical observation of the effect of small propofol on old patients with mechanical ventilation

目的 探讨小剂量异丙酚在老年危重病人机械通气时的应用。方法 对 32例术后需呼吸机辅助通气的老年患者随机分两组 :对照组 (异丙酚常规用量 ) 1 8例 ,研究组 (小剂量异丙酚 ) 1 4例 ,分别在镇静前给一定的异丙酚负荷量。对照组给异丙酚 40～ 1 0 0 mg,研究组给异丙酚 2 0～60 mg,均在 5～ 1 0 min内推注完 ,随后对照组以异丙酚 1～ 5mg/ kg· h- 1 ,研究组以异丙酚 0 .3～ 1 .5mg/ kg· h- 1分别采用微量泵持续泵入。结果 静注后两组镇静效果达到 Ramsay氏 ～ 级所需时间 :对照组 (1 5± 5) s,研究组 (2 0± 9) s,两组比较无差异 (P>0 .0 5) ;停药后神志恢复时间 :对照组 6～ 1 5min,研究组 35s～ 6min,两组比较有显著差异 (P<0 .0 5) ;两组病人用药前后 BP、HR、R、Sa O2 、Pa O2 、Pa CO2 和 CVP等均有明显改善 (P<0 .0 5) ,但组间差异无显著意义 ,两组病人用药后血压无明显差异 (P>0 .0 5)。结论 异丙酚以 0 .3～ 1 .5mg/ kg· h- 1滴注 ,用于 ICU老年危重患者可达到理想的镇静效果。

Objective Our purpose was to observe the effect of small propofol on old patients with mechanical ventilation.Methods 32 old patients who required mechanical ventilation after abdominal operation were admitted to ICU. 18 patients were assigned to common dose propofol (40～100 mg) and 14 patients to small propofol (20～60 mg). They have been injected for 5～10 min. Then common propofol (1～5 mg·kg -1 ·h -1 ) and small propofol (0.3～1.5 mg·kg -1 ·h -1 ) were given by countinuous infusion.Results After infusion, there were no significant different time to get Ramsay sedation Level Ⅳ～Ⅴ. Compare sedative time was (15±5)s, and research sedative time was (20±9) s ( P >0.05). After stopping giving propofol, compare recovered time was 6～15 min, and research time was 35 s～6 min ( P <0.05). Moreover, the patients' BP, HR, R, SaO 2, PaO 2, PaCO 2 and CVP were better than before ( P <0.05). There were no difference between two groups ( P >0.05).Conclusions Small propfol have a remarkable effect with the mechanical ventilation old patients.