摘要目的 比较在重症监护病房(ICU)内进行机械通气治疗的老年颅脑损伤患者分别应用内泊酚和咪达唑仑进行镇静治疗的效果. 方法 将76例行机械通气的颅脑损伤老年患者分为丙泊酚组38例,咪达唑仑组38例,分析两组患者ICU镇静全程低血压和心动过缓发生率、ICU内治疗时间、理想镇静时间百分数、神经功能评估时间、从进入ICU至脱离呼吸机的时间、脱机时间和拔除气管导管时间的差异. 结果 丙泊酚组患者低血压、心动过缓发生率分别为15.8％ (6/38)、13.2％(5/38),高于咪达唑仑组患者2.6％(1/38)、0.0％ (0/38)(x2=3.93,P=0.047；x2=5.35,p=0.021).丙泊酚组患者ICU内治疗时间(105.2±16.9)h、脱机时间(3.5±0.3)h、拔管时间(1.06±0.03)h和神经功能评估时间(1.12 ±0.03)h,均短于咪达唑仑组(112.2=30.5)h、(5.5±0.4)h、(1.34±0.03)h和(1.41±0.06)h(t=6.35、12.45、20.01、13.43,均P＜0.05).丙泊酚组患者从进入ICU至开始脱离呼吸机的时间(74.6±16.5)h和理想镇静时间百分比(97.6±1.3)％,与咪达唑仑组(75.3±12.5)h和(97.2 ± 1.8)％相比差异无统计学意义(t=1.07、0.57,均P＞0.05). 结论 对ICU内老年颅脑损伤患者使用丙泊酚和咪达唑仑进行镇静是安全和有效的,咪达唑仑对血流动力学的影响优于丙泊酚,但在脱机和拔管时间方面丙泊酚优于咪达唑仑.

abstractsObjective To compare the sedative effect between propofol and midazolam in the aged with traumatic brain injury and undergoing mechanical ventilation in intensive care unit(ICU).Methods Totally 76 cases with traumatic brain injury undergoing mechanical ventilation in ICU were divided into two groups:propofol and midazolam groups(n=38 for each group).The incidence rates of hypotension and bradycardia,the time course in ICU,the percentage of satisfactory sedation time,the average time of neurological assessment,duration from ICU arrival to off,the time of diastasis and tube drawing were compared between the two groups. Results The incidence rate of hypotension and bradycardia were higher in propofol group than in midazolam group [15.8％(6/38),13.2％ (5/38)vs.2.6％(1/38),0％ (0/38),x2 =3.93,5.35,P=0.047,0.021]. The time of treatment,diastasis,tube drawing and neurological assessment during ICU were shorter in propofol group than in midazolam group[(105.2±16.9)h,(3.5±0.3) h,(1.06±0.03) h and (1.12±0.(03) h vs.(112.2±30.5)h,(5.5±0.4) h,(1.34±0.03) hand (1.41±0.06)h,t=6.35,12.45,20.01,13.43,all P＜0.05].There were no differences in the duration from ICU arrival to off and the percentage of satisfactory sedation time between the two groups[(74.6±16.5) h and (97.6±1.3)％ vs.(75.3±12.5)hand(97.2±1.8)％,t=1.07,0.57,both P＞0.05]. Conclusions Propofol and midazolam are safe and effective for sedation in the aged patients with traumatic brain injury.Midazolam is better in hemodynamics effects than propofol,while propofol outgoes midazolam in the time of diastasis and tube drawing.