CAJ | 학술논문

目的评价咪达唑仑复合异丙酚镇静对ICU机械通气患者谵妄的影响.方法选择需行镇静镇痛气管插管、呼吸机辅助呼吸的ICU患者522例,年龄28～ 64岁,体重41～ 82 kg,性别不限,根据治疗期间的镇静方法分为2组:咪达唑仑镇静组(M组,n=240)和咪达唑仑+异丙酚镇静组(MP组,n=232).M组和MP组静脉输注咪达唑仑0.03 ～ 0.17 mg/min镇静,静脉输注舒芬太尼0.07～ 0.14 μg/min镇痛.MP组当循环稳定、压力支持8～ 10 cmH2O、潮气量＞400 ml、通气频率＜25次/min、吸入氧浓度＜45％时,改为静脉输注异丙酚0.8～ 2.0 mg/min镇静,镇静时间12～24 h.机械通气期间维持Richmond躁动-镇静量表评分-1 ～-2分.记录谵妄的发生情况和持续时间,并根据Richmond躁动-镇静量表评分将其分为兴奋型、抑制型和混合型,记录不同类型谵妄的发生情况和持续时间.结果 2组谵妄发生率和持续时间比较差异无统计学意义(P＞0.05).与M组比较,MP组兴奋型谵妄发生率降低(P＜0.05),抑制型和混合型谵妄的发生率、不同类型谵妄持续时间差异无统计学意义(P＞0.05).结论咪达唑仑复合异丙酚可降低ICU机械通气患者兴奋型谵妄的发生,但不能缩短谵妄持续时间.
목적 평개미체서륜복합이병분진정대ICU궤계통기환자섬망적영향.방법 선택수행진정진통기관삽관、호흡궤보조호흡적ICU환자522례,년령28～ 64세,체중41～ 82 kg,성별불한,근거치료기간적진정방법분위2조:미체서륜진정조(M조,n=240)화미체서륜+이병분진정조(MP조,n=232).M조화MP조정맥수주미체서륜0.03 ～ 0.17 mg/min진정,정맥수주서분태니0.07～ 0.14 μg/min진통.MP조당순배은정、압력지지8～ 10 cmH2O、조기량＞400 ml、통기빈솔＜25차/min、흡입양농도＜45％시,개위정맥수주이병분0.8～ 2.0 mg/min진정,진정시간12～24 h.궤계통기기간유지Richmond조동-진정량표평분-1 ～-2분.기록섬망적발생정황화지속시간,병근거Richmond조동-진정량표평분장기분위흥강형、억제형화혼합형,기록불동류형섬망적발생정황화지속시간.결과 2조섬망발생솔화지속시간비교차이무통계학의의(P＞0.05).여M조비교,MP조흥강형섬망발생솔강저(P＜0.05),억제형화혼합형섬망적발생솔、불동류형섬망지속시간차이무통계학의의(P＞0.05).결론 미체서륜복합이병분가강저ICU궤계통기환자흥강형섬망적발생,단불능축단섬망지속시간.
Objective To evaluate the effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in the intensive care unit (ICU).Methods Five hundred and twenty-two patients who required sedation and analgesia,endotracheal intubation and mechanical ventilation used to assist respiration,aged 28-64 yr,weighing 41-82 kg,were randomized into 2 groups according to the sedation protocols during therapy:sedation with midazolam group (group M,n =240) and sedation with midazolam + propofol group (group MP,n=232).In M and MP groups,sedation was induced with midazolam infusion 0.03-0.17 mg/min,and analgesia was induced with sufentanil infusion 0.07-0.14 μg/min.In group MP,when hemodynamics was stable,pressure support was 8-10 cmH2O,tidal volume＞400 ml,RR ＜25 bpm,and FiO2＜45％,sedation was induced with propofol infusion 0.8-2.0 mg/min instead,lasting for 12-24 h.Richmond Agitation Sedation Scale score was maintained at-1 to-2 during vcntilation.The development and duration of delirium were recorded.Delirium was divided into hyperactive delirium,hypoactive delirium and mixed delirium 3 subtypes,and the development and duration of the 3 subtypes of delirium were also recorded.Results There was no significant difference between the two groups in the incidence and duration of delirium.Compared to group M,the incidence of hyperactive delirium was significantly decreased,and no significant change was found in the incidence of hypoactive delirium and mixed delirium and the duration of the 3 subtypes of delirium in group MP.Conclusion Sedation with midazolam and propofol can decrease the development of hyperactive delirium,but can not shorten the duration of delirium in mechanically ventilated patients in the ICU.