右美托咪定、咪達唑侖對急性左心衰竭機械通氣患者的鎮靜作用

張裕生

[摘要] 目的 分析急性左心衰竭（ALHF）者行機械通氣時分別應用右美托咪定、咪達唑侖臨床鎮靜效果差異。方法 方便選取2018年1—10月期間63例ALHF行機械通氣者為研究對象，按治療小組不同分組，對照組患者應用咪達唑侖鎮靜（共31例）、觀察組以右美托咪定鎮靜（共32例），對不同時間段兩組循環、呼吸指標變化情況進行觀察，比較患者藥物起效、清醒時間、鎮靜評分差異，統計治療期間不良反應發生情況。 結果 兩組插管即刻、通氣4 h相關循環呼吸指標水平比較差異無統計學意義（P>0.05），通氣2 h時對照組MAP、HR為（90.73±6.05）mmHg、（127.03±10.84）次/min高于觀察組（83.61±5.27）mmHg、（115.92±10.54）次/min，（t=4.986，4.125，P<0.05）;觀察組鎮靜評分、藥物起效、清醒時間依次為（4.72±0.64）分、（106.27±13.08）s、（29.84±5.21）min，對照組為（4.06±0.73）分、（98.54±10.65）s、（80.03±4.19）min，組間比較觀察組鎮靜好、藥物起效慢、清醒用時短（t=3.819，2.568，42.053，P<0.05）;同時兩組不良反應比較，觀察組發生率6.25%低于對照組16.13%（χ2=4.911，P<0.05）。 結論 對ALHF行機械通氣者以右美托咪定進行鎮靜誘導、通氣鎮靜維持，通氣期間患者循環、呼吸功能影響小，鎮靜效果良，清醒用時短，不良反應發生少，安全性高。

[關鍵詞] 鎮靜;咪達唑侖;機械通氣;右美托咪定;急性左心衰竭

[中圖分類號] R614? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-0742（2019）05（c）-0125-03

[Abstract] Objective To analyze the clinical sedative effects of dexmedetomidine and midazolam in patients with acute left heart failure （ALHF）. Methods Convenient select sixty-three patients with ALHF mechanical ventilation were enrolled in the study from January to October 2018. The patients were divided into different groups according to the treatment methods. The patients in the control group were treated with midazolam （31 cases） and the observation group was sedated with dexmedetomidine （32 total）. For example， the changes of the circulation and respiratory indexes of the two groups were observed at different time periods， and the differences in drug onset， waking time and sedation score were compared， and the adverse reactions occurred during the treatment. Results There was no difference in the levels of circulatory respiration between the two groups immediately after intubation and ventilation for 4 h（P>0.05）. The MAP and HR of the control group were （90.73±6.05） mmHg and （127.03±10.84） times/min higher than the observation group of （83.61±5.27） mmHg， （115.92±10.54） times/min（t=4.986， 4.125， P<0.05）; observation group of sedation score， drug onset， awake time were （4.72±0.64） points， （106.27±13.08） s， （29.84±5.21） min， the control group was （4.06±0.73）points， （98.54±10.65） s， （80.03±4.19） min. The sedation was good and the drug started slowly. The time of awake was short （t=3.819， 2.568，42.053， P<0.05）. At the same time， the incidence of 6.25% in the observation group was 16.13% lower than that in the control group （χ2=4.911， P<0.05）. Conclusion In patients with mechanical ventilation of ALHF， dexmedetomidine is used for sedation induction and sedation. During ventilating， with little influence on circulation and respiratory function， good sedation effect， short awake time， less adverse reactions and high safety.