CAJ | 학술논문

目的比较右美托咪定和咪达唑仑用于机械通气患者镇静的效果.方法拟在镇静下行机械通气治疗24 h的重症监护室(ICU)患者60例,年龄20 ～ 64岁,体重指数21 ～ 25 kg/m2,急性生理与慢性健康Ⅱ评分10 ～ 25分,采用随机数字表法,将患者随机分为2组(n=30):咪达唑仑组(M组)和右美托咪定组(D组).M组:静脉注射咪达唑仑0.05 mg/kg负荷量后,以0.03～0.20mg· kg-1·h-1的速率静脉输注;D组:静脉注射右美托咪定1 μg/kg负荷量后,以0.2～0.7μg·kg-1·h-1的速率静脉输注,维持2组Ramsay镇静评分2～4分.记录镇静期间ICU医生对镇静效果的满意度、低血压和心动过缓的发生情况.记录开始镇静至停止镇静后2h谵妄的发生情况、苏醒时间和苏醒后2h内再入睡的发生情况.结果与M组比较,D组ICU医生对镇静效果的满意度升高,苏醒时间缩短,苏醒后2h内再入睡率和谵妄发生率降低(P＜0.05或0.01),低血压和心动过缓的发生率差异无统计学意义(P＞0.05).结论右美托咪定用于机械通气患者镇静的效果优于咪达唑仑.
목적 비교우미탁미정화미체서륜용우궤계통기환자진정적효과.방법 의재진정하행궤계통기치료24 h적중증감호실(ICU)환자60례,년령20 ～ 64세,체중지수21 ～ 25 kg/m2,급성생리여만성건강Ⅱ평분10 ～ 25분,채용수궤수자표법,장환자수궤분위2조(n=30):미체서륜조(M조)화우미탁미정조(D조).M조:정맥주사미체서륜0.05 mg/kg부하량후,이0.03～0.20mg· kg-1·h-1적속솔정맥수주;D조:정맥주사우미탁미정1 μg/kg부하량후,이0.2～0.7μg·kg-1·h-1적속솔정맥수주,유지2조Ramsay진정평분2～4분.기록진정기간ICU의생대진정효과적만의도、저혈압화심동과완적발생정황.기록개시진정지정지진정후2h섬망적발생정황、소성시간화소성후2h내재입수적발생정황.결과 여M조비교,D조ICU의생대진정효과적만의도승고,소성시간축단,소성후2h내재입수솔화섬망발생솔강저(P＜0.05혹0.01),저혈압화심동과완적발생솔차이무통계학의의(P＞0.05).결론 우미탁미정용우궤계통기환자진정적효과우우미체서륜.
Objective To compare the efficacy of sedation with dexmedetomidine versus midazolam in mechanically ventilated patients.Methods Sixty patients aged 20-64 yr,with body mass index 21-25 kg/m2,APECHE Ⅱ score 10-25,requiring 24 h of nechanical ventilation in intensive care unit (ICU),were randomly divided into 2 groups (n=30 each): midazolam group (group M) and dexmedetomidine group (group D).A loading dose of midazolam 0.05 mg/kg was injected intravenously,followed by infusion at 0.03-0.20 mg· kg-1 · h-1 in group M.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously,followed by infusion at 0.2-0.7 μg· kg-1 · h-1 in group D.Ramsay sedation score was maintained at 2-4.The satisfaction of the doctors in ICU with the sedative efficacy,hypotension and bradycardia were recorded.Delirium was recorded starting from the begging of sedation to 2 h after the end of sedation.The emergence time and occurrence of falling asleep again within 2 h after waking were also recorded.Results Compared with M group,the satisfactory level of the doctors in ICU with the sedative efficacy was significantly increased,the emergence time was significantly shortened and the incidences of falling asleep again within 2 h after waking and delirium were significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidence of hypotension and bradycardia in group D (P ＞ 0.05).Conclusion The efficacy of sedation with dexmedetomidine is better than that of midazolam in mechanically ventilated patients.