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(yīng)用右美托咪定、咪達唑侖臨床鎮(zhèn)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(yīng)用咪達唑侖鎮(zhèn)靜（共31例）、觀察組以右美托咪定鎮(zhèn)靜（共32例），對不同時間段兩組循環(huán)、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(zhèn)靜評分差異，統(tǒng)計治療期間不良反應(yīng)發(fā)生情況。 結(jié)果 兩組插管即刻、通氣4 h相關(guān)循環(huán)呼吸指標水平比較差異無統(tǒng)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(zhèn)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(zhèn)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(yīng)比較，觀察組發(fā)生率6.25%低于對照組16.13%（χ2=4.911，P<0.05）。 結(jié)論 對ALHF行機械通氣者以右美托咪定進行鎮(zhèn)靜誘導(dǎo)、通氣鎮(zhèn)靜維持，通氣期間患者循環(huán)、呼吸功能影響小，鎮(zhèn)靜效果良，清醒用時短，不良反應(yīng)發(fā)生少，安全性高。

[關(guān)鍵詞] 鎮(zhèn)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.