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目的探讨咪达唑仑、咪达唑仑复合丙泊酚治疗对重症监护病房(ICU)患者拔除气管插管后谵妄发生情况。方法 127例ICU接受机械通气同时需要镇静治疗的患者,根据镇静剂使用方式分为咪达唑仑组(M组,68例)及咪达唑仑复合丙泊酚过渡组(MP组,59例),两组咪达唑仑用量相同[先静脉注射2~3 mg,继之以0.05 mg/(kg·h)]静脉推泵维持。当患者血流动力学平稳,呼吸机参数模式调整为CPAP/PSV模式,压力支持8~10 cm H_2O(1 cm H_2O=0.098 kPa)、潮气量>400 ml、通气频率<25次/min、吸氧浓度<45%,自主呼吸良好时,M组停用咪达唑仑静脉推泵后拔管,MP组准备拔管前2 h停用咪达唑仑,改为丙泊酚[0.5~4.0 mg/(kg·h)]镇静,镇静后维持时间2 h,停用镇静药物(期间实行唤醒计划),满足撤机条件后拔除气管插管,镇静机械通气期间维持Richmond躁动镇静评分量表(RASS)评分-1~-2分,拔管后详细记录谵妄的发生情况及持续时间,比较两组患者拔除气管插管后谵妄发生率。结果 M组谵妄发生率为25.0%(17/68),ICU滞留时间为(2.49±0.50)d,均明显高于MP组的10.2%、(2.29±0.59)d,差异具有统计学意义(P<0.05)。两组患者的谵妄持续时间比较差异无统计学意义(P>0.05)。结论咪达唑仑复合丙泊酚治疗拔除气管插管后患者的谵妄发生率较低,可缩短ICU滞留时间,但复合丙泊酚后不能缩短谵妄持续时间。
Objective To investigate the incidence of delirium after midazolam and midazolam combined with propofol in intensive care unit (ICU) patients after intubation. Methods A total of 127 ICU patients undergoing mechanical ventilation and requiring sedation were divided into two groups: midazolam group (M group, 68 cases) and midazolam combined propofol group (MP group, 59 cases) , The same amount of midazolam in the two groups [first intravenous injection of 2 ~ 3 mg, followed by 0.05 mg / (kg · h)] intravenous pump to maintain. When the patient’s hemodynamics were stable and the ventilator parameter mode was adjusted to CPAP / PSV mode, the pressure support was 8-10 cm H 2 O (1 cm H 2 O = 0.098 kPa), the tidal volume was> 400 ml, the ventilation frequency was less than 25 times / min, Oxygen concentration <45%, spontaneous breathing is good, M group discontinued midazolam withdrawal after extubation, MP group ready to withdraw 2 h before midazolam, replaced by propofol [0.5 ~ 4.0 (kg · h)] for 2 h after sedation, sedation medication was discontinued (waking up plan was implemented), intubation was performed after the weaning condition was met and the Richmond Restlessness Sedation Rating Scale was maintained during sedation mechanical ventilation RASS) score of -1 ~ -2 points, after extubation detailed records of occurrence and duration of delirium, the incidence of delirium after tracheal intubation was compared between the two groups. Results The incidence of delirium was 25.0% (17/68) in M group and (2.49 ± 0.50) d in ICU, which was significantly higher than that in MP group (10.2%, 2.29 ± 0.59) d, respectively <0.05). There was no significant difference in duration of delirium between the two groups (P> 0.05). Conclusions Midazolam combined with propofol has a lower incidence of delirium in patients with intubation after intubation, which can shorten the duration of ICU, but can not shorten the duration of delirium after combined with propofol.