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目的对比观察咪达唑仑镇静与咪达唑仑镇静加串连通气管治疗呼吸性碱中毒疗效及呼吸性碱中毒纠正前后脑氧代谢的改变。方法把ICU无颅脑伤的创伤性多发伤伴呼吸性碱中毒病人35例,随机分为对照组(镇静组)17例与实验组(镇静加串连通气管60 ml)18例。先于右颈内静脉球和左桡动脉置管,分别于治疗前及治疗后1、2、24 h记录动静脉血气并计算脑氧利用率。结果用咪唑安定治疗呼吸性碱中毒有效,但时间较长,至治疗后24 h PaCO2分压增加与治疗前比较有显著改变(P<0.05);实验组串连通气管增加死腔加镇静办法1 h后能显著提高PaCO2分压,与治疗前比较有显著改变(P<0.05)。镇静治疗使氧利用率减少,对照组24 h时与镇静前氧利用率相比有显著改变(P<0.05);实验组1 h时与镇静前氧利用率比有显著改变(P<0.05)。结论串连医用通气管增加解剖死腔和镇静治疗都是控制呼吸性碱中毒的有效措施,但前者更适用于临床。串连医用通气管增加解剖死腔的方法,可有效改善脑氧代谢。
Objective To compare the effects of midazolam sedation and midazolam sedation plus tandem ventilation tube in the treatment of respiratory alkalosis and the changes of cerebral oxygen metabolism before and after the correction of respiratory alkalosis. Methods Totally 35 patients with traumatic multiple trauma and respiratory alkalosis without craniocerebral injury in ICU were randomly divided into control group (sedation group) and experimental group (sedation plus tandem ventilation tube 60 ml). Prior to the insertion of the right internal jugular bulb and the left radial artery, arterial and venous blood gas were recorded before treatment and 1, 2, 24 h after treatment respectively, and the cerebral oxygen utilization rate was calculated. Results Respiratory alkalosis with midazolam was effective, but for a long time, the partial pressure of PaCO2 increased 24 h after treatment compared with that before treatment (P <0.05). In the experimental group, dead space and sedation were increased After 1 h, the partial pressure of PaCO2 was significantly increased, with a significant change compared with that before treatment (P <0.05). Sedative treatment reduced the oxygen utilization rate (P <0.05), while the oxygen utilization rate in the control group at 24 h was significantly different from that before sedation (P <0.05) . Conclusions Serial medical ventilation tube to increase anatomical dead space and sedation are effective measures to control respiratory alkalosis, but the former is more suitable for clinical use. Serial medical ventilation tube to increase anatomical dead space method can effectively improve cerebral oxygen metabolism.