右美托咪定与咪达唑仑用于重症监护病房连枷胸并肺损伤患者镇静的效果比较

连枷胸并肺损伤是一类较严重的胸部外伤，肺挫伤的胸部外伤患者需要呼吸机的支持治疗。患者因病情较重而易出现烦躁烦躁不安预防和控制烦躁较为重要，为此我院采用右美托咪定治疗连枷胸并肺损伤者18例，取得了满意疗效，现报道如下。

1临床资料

1.1一般资料收集潍坊市人民医院重症医学科2009年9月~2011年8月连枷胸并肺损伤需行机械通气患者36例,随机将患者分为右美托咪定组18例和咪达唑仑组18例。除外儿童（年龄<14岁）3d以内死亡者合并严重颅脑损伤者（GCS评分8分或以下）。右美托咪定组平均年龄为34.2岁,急性生理学与慢性健康状况评分(APACHEⅡ评分)为(13.8±

2.2)分，肺损伤简易评分[1]14±8.2分。咪达唑仑组的平均年龄为36.1岁,,APACHEⅡ评分为(12.9±

3.1)分，肺损伤简易评分13±

4.2分。两组间一般资料的比较无显著性差异(P>0.05)。

1.2方法两组患者均给予预防应用抗生素，限制性液体复苏，初期机械通气给予压力控制（PCV）或同步间歇指令通气加压力支持通气（SIMV+PSV），脱机

doi:10.3969/j.issn.1008-4118.2012.02.02

右美托咪定与咪达唑仑用于重症监护病房连枷胸并

肺损伤患者镇静的效果比较

王海波,李克鹏,邓泽冰

(潍坊市人民医院重症医学科,山东潍坊261041）

摘要:目的探讨右美托咪定与咪达唑仑对连枷胸并肺损伤患者的临床效果。方法连枷胸并肺损伤需要行机械通气的患者36例，随机将患者分为右美托咪定组18例和咪达唑仑组18例。右美托咪定组:给予右美托咪定负荷量1μg/(kg·h)经静脉泵注射20min,维持剂量0.2μg~0.7μg/(kg·h)持，咪达唑仑组:负荷量(0.01-0.3)mg/kg咪达唑仑进行镇静诱导,维持量(0.03~0.3)mg/(kg·h)。比较两组患者的心率、血压、芬太尼用量、脱机时间，住重症监护病房(ICU)时间等。结果右美托咪定组在机械通气6、24h的心率减慢(P值均< 0.05),而在48h的心率的差异均无显著性(P值均>0.05)。右美托咪定组的芬太尼使用量显著减少(P<0.05)，机械通气时间、住ICU时间缩短(P<0.05)。结论右美托咪定应用于连枷胸并肺损伤患者镇静安全、有效,能减少降压药物及芬太尼的用量,并能减少机械通气时间，缩短住ICU时间。

关键词:右美托咪定/治疗应用；咪达唑仑/治疗应用；连枷胸/治疗应用；肺损伤/治疗

中图分类号：R655.1;R563文献标识码：A文章编号：1008-4118（2012）02-0004-03

The Sedation Effect Comparison of Dexmedetomidine and Midazolam To Treat Patients

with Flail Chest Complicated with Pulmonary Injury in ICU

Wang Haibo,Li Ke-peng,Deng Zebing

(Weifang People's Hospital,Weifang261041,Shandong)

Abstract:Objective To Explore the clinical e fficacy of dexmedetomidine and midazolam for sedation of flail chest compli⁃cated with acute pulmonary contusion patients in intensive care unit.Methods Select thirty-six flail chest complicated with acute pul⁃monary contusion patients treated by ventilatory support;they were randomly divided into two groups to receive either dexmedetomi⁃dine or midazolam The dexmedetomidine group(Group A,n=18)received a loading dose of1g·kg-1·h-1for20min,followed by con⁃tinuous infusion at0.2~0.7g·kg-1·h-1.The midazolam group(Group B,n=18)received a loading dose of0.01-0.3mg/kg,followed by continuous infusion at0.03-0.3mg·kg-1·h-1.The heart rate.Mechanical ventilation time，blood pressure,fentanyl dosage,dura⁃tion in ICU were compared between the2groups.Results Compared with Group B,the heart rate in Group A was significantly slower within24h(P<0.05),and the heart rates were similar between the2groups during48h(P>0.05).Moreover,the Mechanical ven⁃tilation time and the demand for fentanyl,duration of ICU stay were less in Group A compared with those in Group B(P<0.05).Con⁃clusion Dexmedetomidine is safe and effective for the sedation of flail chest complicated with acute pulmonary contusion patients, which can reduce the demand for fentanyl,the Mechanical ventilation time and the duration of ICU stay.

Key words:Dexmedetomidine;midazolam;flail chest;pulmonary contusion

通信作者：李克鹏，Email：likepengsuda@