七氟烷与丙泊酚对重症监护病房机械通气患者拔管和苏醒时间及心肌酶水平与预后的影响

Effects of sevoflurane and propofol on extubation time,waking time,myocardial enzymes and prognosis in patients undergoing mechanical ventilation in intensive care unit

目的探讨七氟烷与丙泊酚对重症监护病房机械通气患者拔管和苏醒时间、心肌酶水平以及预后的影响。方法选取2016年6月至2017年12月浙江省舟山医院重症监护病房收治患者66例,采用随机数字表法分为七氟烷组(33例)与丙泊酚组(33例)。2组均行机械通气,镇静药物分别使用七氟烷与丙泊酚。比较2组患者用药前后生命体征,同时记录停药后拔管时间及苏醒时间。比较2组患者用药前及用药后12、24、48 h心肌肌钙蛋白I(cTnI)及肌酸激酶同工酶(CK-MB)水平和镇静过程中不良反应发生情况。比较2组30 d心血管事件发生情况。结果用药前2组收缩压、舒张压、心率、呼吸频率比较差异均无统计学意义(均P>0. 05),用药后2组收缩压、舒张压、心率、呼吸频率均明显低于用药前,且七氟烷组明显低于丙泊酚组[(128±5) mmHg(1 mmHg=0. 133 kPa)比(136±5) mmHg、(72±6) mmHg比(78±5) mmHg、(86±10)次/min比(92±10)次/min、(15±5)次/min比(18±5)次/min],差异均有统计学意义(均P <0. 05)。七氟烷组的拔管时间及苏醒时间均短于丙泊酚组[(15±10) min比(99±32) min、(36±13) min比(163±122) min],差异均有统计学意义(均P <0. 001)。用药前2组cTnI及CK-MB水平比较差异均无统计学意义(均P> 0. 05),用药后2组cTnI及CK-MB水平均较用药前明显下降,且七氟烷组用药后12、24、48 h的cTnI及CK-MB水平均明显低于丙泊酚组,差异均有统计学意义(均P <0. 05)。七氟烷组不良反应发生率明显低于丙泊酚组[6. 1%(2/33)比30. 3%(10/33)],差异有统计学意义(P=0. 025)。七氟烷组30 d心血管事件发生率明显低于丙泊酚组[9. 1%(3/33)比27. 3%(9/33)](P=0. 035)。结论七氟烷相较于丙泊酚的镇静效果更好,拔管及苏醒时间更早,同时对心肌具有一定保护作用,能降低心血管事件发生率。

Objective To explore the effects of sevoflurane and propofol on extubation time,waking time,myocardial enzymes and prognosis in critical patients undergoing mechanical ventilation.Methods Sixty-six critical patients undergoing mechanical ventilation in intensive care unit of Zhoushan Hospital,Zhejiang Province were enrolled from June 2016 to December 2017.According to different sedatives,they were randomly divided into sevoflurane group(33 cases)and propofol group(33 cases).Vital signs,extubation time and waking time were recorded.Levels of cardiac troponin I(cTnI)and creatine kinase isozyme(CK-MB)were detected before and 12,24,48 h after sedation.Adverse reactions and cardiovascular events were observed during sedation.Results There was no significant difference of systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and respiratory rate(RR)between groups before sedation(all P>0.05).After sedation,SBP,DBP,HR and RR significantly decreased in both groups and they were significantly lower in sevoflurane group than those in propofol group[(128±5)mmHg vs(136±5)mmHg,(72±6)mmHg vs(78±5)mmHg,(86±10)times/min vs(92±10)times/min,(15±5)times/min vs(18±5)times/min](all P<0.05).Extubation time and waking time in sevoflurane group were significantly shorter than those in propofol group[(15±10)min vs(99±32)min,(36±13)min vs(163±122)min](both P<0.001).There was no significant difference of cTnI and CK-MB levels between groups before sedation(both P>0.05).After sedation,levels of cTnI and CK-MB significantly decreased in both groups;cTnI and CK-MB levels 12,24,48 h after sedation in sevoflurane group were significantly lower than those in propofol group(all P<0.05).Incidence of adverse reactions in sevoflurane group was significantly lower than that in propofol group[6.1%(2/33)vs 30.3%(10/33)](P=0.025).The 30 d incidence of cardiovascular events in sevoflurane group was significantly lower than that in propofol group[9.1%(3/33)vs27.3%(9/33)](P=0.035).Conclusion Compared with propofol,sevoflurane shows better sedative effect,earlier extubation and waking,better protective effect on myocardium and less cardiovascular events.