论文部分内容阅读
目的 观察咪唑安定和丙泊酚联用对危重患者镇静-遗忘作用的影响.方法 选择重症加强治疗病房(ICU)行机械通气2～4 d的患者60例,随机分为丙泊酚组、咪唑安定组和咪唑安定加丙泊酚联用组,每组20例.分别于用药后1、2和3 d唤醒患者并出示不同颜色、图形、数字的卡片,于患者停用机械通气完全清醒后评估药物对其镇静-遗忘作用的影响.结果 ①丙泊酚、咪唑安定和联用组分别有70%、95%和90%的患者产生遗忘,停药30 min后患者均恢复记忆.②咪唑安定组静脉推注负荷量药物起效的时间((5.1±2.8)min]和停药清醒后拔除气管插管的时间[(2.7±0.3)h]均较丙泊酚组[(2.7±1.1)min、(0.7±0.2)h]、联用组[(3.1±1.3)min、(1.2±0.6)h]明显延长(P均＜0.01);丙泊酚组和联用组药物起效时间和停药清醒后拔除气管插管时间相近,差异无统计学意义(P均＞0.05).③镇静费用咪唑安定组[(1 200±112)元]和联用组[(1 300±132)元]接近,丙泊酚组[(2 100±125)元]高于咪唑安定组约75%(P＜0.01).结论 丙泊酚与咪唑安定联合用药既可确保患者产生镇静-遗忘效应,减少各自的用量,降低药物不良反应,又有利于降低患者的住院费用,可能是ICU危重患者较好的镇静-遗忘治疗方案.“,”Objective To observe the effects of sedation with midazolam and propofol on anterograde amnesia in critical patients.Methods Sixty selected patients on mechanical ventilation in intensive care unit (ICU)were randomly divided into three subgroups(propofol,midazolam,and midazolam and propofol combination group),with 20 cases in each group.Patients who were awakened from sedation were showed with a card depicted with different colors,figures and numbers.When patients were totally conscious after weaning from mechanicaI ventilation,the influence of the different methods of sedation on anterograde amnesia in propofol,midazolam and the combination group,respectively.All the patients recovered their propofol and combination group,time of onset was obviously prolonged after an intravenous injection of a load dose in midazolam group[(2.7±1.1)minutes and(3.1±1.3)minutes vs.(5.1±2.8)minutes],also was time of extubation after regaining of consciousness[(0.7±0.2)hour and(1.2±0.6)hours vs.(2.7±0.3)hours,all P＜0.01].There was no significant difference between propofol group and the combination higher than that of midazolam[(1 200±112)yuan,P＜0.01],but cost of sedatives in the combination group[(1300±132)yuan3 was similar to that in midazolam group(P＞0.05).Conclusion Combination of midazolam and propofol can not only ensure anterograde amnesia in critical patients,reduce drug dosage and adverse reactions,but also can help reduce the hospital expenses.This method may be a better sedation program in ICU.