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论著:右美托咪定与咪达唑仑对危重病患者镇静效果的比较
Comparison of the Sedative Effects of Dexmedetomidine and Midazolam for Critically Ill Patients
张宝成 钟志越 李宏治 梁晓俊 黎俊 申捷
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作者单位:复旦大学附属金山医院重症监护室
中文关键字:右美托咪定;咪达唑仑;达镇静满意时间;停药后唤醒时间;C反应蛋白
英文关键字:Dexmedetomidine; Midazolam; Time achieved satisfied sedetion; Awakness time after drug withdrawal; C reactive protein
中文摘要:目的:探讨咪达唑仑、右美托咪定单用以及两者联合用药对重症监护室危重病患者的镇静效果及它们对C反应蛋白(C reactive protein,CRP)的影响。方法:复旦大学附属金山医院重症监护室行机械通气的患者60例,随机分为咪达唑仑组(n=18)、右美托咪定组(n=22)及咪达唑仑联合右美托咪定组(n=20)。每组患者每24 h停药唤醒1次。咪达唑仑组:首次负荷剂量0.05 mg/kg,以后0.02~0.08 mg/(kg·h)静脉注射维持;右美托咪定组:首次负荷剂量1μg/kg(>10 min),以后0.2~0.7μg/(kg·h)静脉注射维持;咪达唑仑联合右美托咪定组:首次负荷剂量的咪达唑仑0.05 mg/kg,然后右美托咪定静脉注射维持0.2~0.7μg/(kg·h)。分别记录3组达镇静满意时间,持续用药24h后心率、血氧饱和度变化,用药前CRP,用药24 h和72 h后CRP,停药后唤醒时间,呼吸、心率抑制不良反应发生情况。结果:右美托咪定组4例患者出现心率减慢(<60次/min),停药后可随时唤醒,无呼吸抑制不良反应。咪达唑仑组6例患者出现呼吸抑制,平均停药后唤醒时间为40 min。咪达唑仑联合右美托咪定组无呼吸抑制、心率减慢等不良反应。咪达唑仑组达镇静满意时间显著短于右美托咪定组(P<0.05),右美托咪定组停药后唤醒时间显著短于咪达唑仑组(P<0.05),咪达唑仑组用药前后CRP无显著变化(P>0.05),右美托咪定组及咪达唑仑联合右美托咪定组用药后CRP较用药前显著下降(P<0.05)。结论:右美托咪定镇静起效较慢,无呼吸抑制,停药后可随时唤醒;咪达唑仑镇静起效快于右美托咪定,但存在呼吸抑制不良反应。右美托咪定对减轻应激反应有一定作用。两药联合应用可能是比较满意的镇静方式。
英文摘要:Objective: To compare the sedative effects of dexmedetomidine, midazolam, and the combination of them for critically ill patients in intensive care unit. Methods: Sixty patients undergoing mechanical ventilation in intensive care unit were randomly devided into three groups:midazolam group(n=18), dexmedetomidine group (n=22), dexmedetomidine and midazolam combination group(n=20). Every patient in each group was waken up per 24 h. Midazolam group: an initial loading dose of 0.05 mg/kg midazolam was administered intravenously ,maintenance load 0.02~0.08 mg/(kg·h); dexmedetomidine group: an initial loading dose of 1 μg/kg dexmedetomidine was administered intravenously, maintenance load 0.2~0.7μg/(kg·h); dexmedetomidine and midazolam combination group: an initial loading dose of 0.05 mg/kg midazolam was administered intravenously, maintenance load dexmedetomidine 0.2~0.7 μg/(kg·h). The time to achieve sedation as well as the alteration of the heart rate, oxygen saturation after 24 h, and the wake time after drug withdrawal have been recorded. Adverse reactions, C reactive protein (CRP) in blood before sedation, 24 h and 72 h after sedation have been detected. Results: Four patients in dexmedetomidine group have been observed decreased heart rate (<60 bpm),and after drug withdrawal all of them were wakened up,no one showing respiratory depression. Six patients of midazolam group showed respiratory depression , and the average wake time after drug withdrawal was 40 min. Dexmedetomidine midazolam combination group have not shown any respiratory and heart rate depression. The average time achieved satisfactory sedation in midazolam group was significantly shorter than that in dexmedetomidine group(P<0.05).The average wake time after drug withdrawal in dexmedetomidine group was significantly shorter than that in midazolam group(P<0.05)There was no significant change of CRP in midazolam group.The level of CRP in dexmedetomidine group and dexmedetomidine and midazolam combination group dropped significantly after drug infusion. Conclusions: Though the time to achieve satisfactory sedation state using dexmedetomidine is longer than midazolam,it has no adverse reaction, and the wake time after drug withdrawal is shorter as well. The sedation effect of midazolam is better than dexmedetomidine,but it can induce respiratory depression. Dexmedetomidine can relieve stress reaction. The combination of midazolam and dexmedetomidine will be a better way in sedation.
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