右美托咪定与咪达唑仑镇静在机械通气患者中的应用

摘要

Objective To investigate sedation of dexmedetomidine versus midazolam on me-chanically ventilated patients.Methods Seventy-six mechanically ventilated patients were randomly divided into midazolam group (group M)and dexmedetomidine group (group D).The loading dose and maintenance dose of midazolam was 0.06 mg/kg and 0.04-0.2 mg·kg-1 ·h-1 ,and 1 μg/kg and 0.2-0.7 μg·kg-1 ·h-1 for dexmedetomidine.The drug dose was adjusted according to Ramsay score scale.Time when Ramsay reach 2-4 score,the length of ICU stay,mechanical ventilation time,drug adverse reactions,the levels of inflammation factors were recorded and compared between two groups.Results The length of ICU stay and arousing time in group D was significantly lower than that of group M (P <0.05).The levels of TNF-α,hs-CRP in group D were lower after 24 hr treat-ment than that of group M(P <0.05).The levels of hs-CRP in group D were lower after 48 hr treat-ment than that of group M (P <0.01).Conclusion Dexmedetomidine treatment reduced the lengh of ICU stay and levels of inflammatory factors of mechanical ventilated patients.%目的：观察右美托咪定与咪达唑仑在机械通气患者中的应用。方法将2014年5月至2015年1月我院ICU病房收治的76例需要有创机械通气及持续镇静治疗的患者,按照随机数字表法均分为咪达唑仑组(M组)和右美托咪定组(D组)。M组：咪达唑仑负荷量0.06mg/kg静注,维持量0.04~0.2mg·kg-1·h-1；D组,右美托咪定负荷量1μg/kg静注10min,维持量0.2~0.7μg·kg-1·h-1。根据Ramsay镇静评分调整药物用量,使Ramsay镇静评分维持在2~4分。记录两组患者用药后达到Ramsay镇静评分2~4分的时间、Ramsay镇静评分、ICU住院时间、机械通气时间、唤醒时间。同时采用酶联免疫吸附法(ELISA)检测两组患者用药前、用药后24、48h血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)水平的变化。结果D组患者的ICU住院时间和唤醒时间明显短于M组(P<0.05)。用药后24hD组患者血清TNF-α、hs-CRP水平明显低于M组(P<0.05),两组血清IL-6水平差异无统计学意义；用药后48hD组血清hs-CRP水平明显低于M组(P<0.05),两组患者血清TNF-α、IL-6水平差异无统计学意义。结论有创性机械通气患者使用右美托咪定镇静,缩短患者ICU住院时间,且能有效降低患者体内炎症因子水平。