咪达唑仑与右美托咪啶用于神经外科重症机械通气患者镇静镇痛的临床对比分析

林影芯 张卫星 王昕欣

【摘要】 目的：探究咪達唑仑与右美托咪啶用于神经外科重症机械通气患者镇静镇痛的临床对比。方法：选取本院2015年6月-2017年5月收治的神经外科重症机械通气患者120例作为研究对象，按随机数字表法将其分为咪达唑仑组（n=60）和右美托咪啶组（n=60），分别比较两组镇静效果，用药前后的血气分析，观察两组机械通气时间、拔管时间、撤机时间以及ICU住院时间，并记录不良反应发生率。结果：咪达唑仑组镇静有效率95.00%（57/60）与右美托咪啶组镇静有效率96.67%（58/60）比较，差异无统计学意义（P>0.05）;两组用药后动脉血氧分压（PO2）、血氧饱和度（SpO2）、呼吸频率（RR）均较用药前改善（P<0.05），而用药后两组血气指标比较，差异均无统计学意义（P>0.05）;右美托咪啶组机械通气时间、拔管时间、撤机时间以及ICU住院时间均短于咪达唑仑组（P<0.05）;右美托咪啶组不良反应发生率低于咪达唑仑组（P<0.05）。结论：神经外科重症机械通气患者应用右美托咪啶与咪达唑仑的镇静效果相当，并且右美托咪啶可缩短停药后械通气时间、拔管时间、撤机时间以及ICU住院时间，无呼吸抑制，不良反应较少，改善了患者的预后，有推广应用价值。

【关键词】 咪达唑仑; 右美托咪啶; 神经外科重症; 机械通气; 镇静镇痛

【Abstract】 Objective：To explore the clinical comparative analysis of Midazolam and Dexmedetomidine for sedation and analgesia in neurosurgical severe patients with mechanical ventilation.Method：120 neurosurgical severe patients with mechanical ventilation from June 2015 to May 2017 were selected as the research objects，they were randomly divided into Midazolam group（n=60）and Dexmedetomidine group（n=60）according to the random number table method.The sedative effect，blood gas analysis before and after medication were compared between the two groups.The mechanical ventilation time，extubation time，withdrawal time of the two groups and ICU hospitalization time were observed.And the incidence of adverse reactions of the two groups were recorded.Result：The sedative efficacy rate of the Midazolam group 95.00%（57/60）compared with that of the Dexmedetomidine group 96.67%（58/60），The difference was not statistically significant（P>0.05）.The arterial oxygen partial pressure（PO2），blood oxygen saturation（SpO2）and respiratory rate（RR）were improved in both groups after medication（P<0.05），but there were no significant difference in each blood gas indexes between the two groups after medication（P>0.05）.The ventilation time，extubation time，withdrawal time and ICU hospitalization time in the Dexmedetomidine group were lower than those in the Midazolam group（P<0.05）.The rate of adverse reactions in Dexmedetomidine group was lower than that in the Midazolam group（P<0.05）.Conclusion：The sedative effects of Dexmedetomidine and Midazolam are similar in patients with severe mechanical ventilation in neurosurgery，and Dexmedetomidine can shorten the mechanical ventilation time，extubation time，withdrawal time and ICU hospitalization time after withdrawal of drugs，without respiratory depression，and reduce the adverse reactions，thus improving the prognosis of patients，it has the value of popularization and application.

【Key words】 Midazolam; Dexmedetomidine; Severe nearosurgical condition; Mechanical ventilation; Sedation and analgesiaFirst-authors address：Shenzhen Hospital of Beijing University，Shenzhen 518036，China

doi：10.3969/j.issn.1674-4985.2019.17.015

神经外科重症患者最为常见的并发症为呼吸衰竭，随着医疗技术不断研究与进步，临床上已广泛推广和使用呼吸机提高呼吸衰竭的抢救成功率[1]。而合理应用镇静剂对提高神经重症机械通气患者机械通气依从性并缓解疼痛具有重要的价值及意义，故备受临床医师的关注与重视[2-3]。因此如何选用一种合适的既能改善患者精神症状、缓解疼痛，又不对患者意识状态产生不利影响的镇静药物成为神经外科医师亟待解决的问题[4-5]。本文探讨咪达唑仑与右美托咪啶用神经重症机械通气患者镇静镇痛的临床对比分析，取得满意效果，现报道如下。

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