异丙酚、咪达唑仑和右美托咪啶对ICU脓毒症患者及动脉血气的影响
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Effect of propofol, midazolam and dexmedetomidine on ICU patients with sepsis and on arterial blood gas
背景与目的
观察异丙酚、咪达唑仑和右美托咪啶对重症监护病房(ICU)脓毒症患者及动脉血气(ABG)的影响。
方 法
选择上海交通大学仁济医院2015年5月至2019年1月收治的ICU脓毒症患者429例作为研究对象进行前瞻性分析。所有患者均接受抗感染治疗、纠正休克、改善微循环等基础治疗。将152例使用异丙酚镇静组列为A组，146例使用咪达唑仑镇静组为B组，131例使用右美托咪定镇静组为C组。比较三组患者治疗前后舒张压(DBP)、收缩压(SBP)、心率(HR)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、心肌肌钙蛋白T (cTnT)、肌酸激酶(CK-MB)的变化。APACHEⅡ评分被用来评估镇静效果。记录患者苏醒时间、ICU住院时间及不良反应。
结 果
A、B、C组治疗前HR、收缩压、舒张压、PaO2、PaCO2、cTnT、CK MB、APACHE评分及治疗后收缩压、舒张压、cTnT、HR比较，差异无统计学意义(P>0.050)。治疗后A、B两组CK-MB、APACHE评分无显著性差异(P>0.050)。A组苏醒时间明显长于B、C组(P<0.001)
结 论
咪达唑仑、右美托咪啶用于ICU脓毒症患者的镇静治疗是安全有效的，但右旋美托咪啶对血压和心功能的保护作用最好，值得临床使用。
原始文献摘要
JIA DING, YUWEN CHEN, and YUAN GAO.Effect of propofol, midazolam and dexmedetomidine on ICU patients with sepsis and on arterial blood gas.EXPERIMENTAL AND THERAPEUTIC MEDICINE 18: 4340-4346, 2019
Objective:Effects of propofol, midazolam and dexmedetomidine on patients with sepsis in intensive care unit (ICU) and on arterial blood gas (ABG) were studied.
Method:In total 429 ICU patients with sepsis, admitted to Renji Hospital, School of Medicine, Shanghai Jiaotong University from May 2015 to January 2019, were selected as research subjects for a prospective analysis. All patients received basic treatment, such as anti-infection treatment, correction of shock and improvement of microcirculation. One hundred and fiftytwo patients who were treated with propofol for sedation served as group A,146 patients who were treated with midazolam for sedation served as group B, and 131 patients who were treated with dexmedetomidine for sedation served as group C. The three groups of patients were compared in terms of diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR),arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) before and after treatment.APACHE Ⅱ score was used to evaluate the sedative effects.The wake-up time of the patients, the length of ICU stay and the adverse reactions were recorded.
Result:There was no significant difference among groups A, B and C in terms of HR, SBP,DBP, PaO2, PaCO2, cTnT, CKMB and APACHE Ⅱ score before treatment, and SBP, DBP, cTnT and HR after treatment(P>0.050). After treatment, there was no significant difference between groups A and B with respect to CK-MB and APACHE Ⅱ score (P>0.050). The wakeup time in group A was significantly longer than that in groups B and C (P<0.001).
Conclusion: In conclusion, propofol, midazolam and dexmedetomidine are effective and safe in the sedative treatment of ICU patients with sepsis, but dexmedetomidine has the best effect on protecting blood pressure and cardiac functions, which is worthy of use in the clinic.
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翻译：唐剑 编辑：冯玉蓉 审校：王贵龙