目的 研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。 方法 将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。 结果 实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。 结论 急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。
目的 评价重症急性左心衰竭患者机械通气时采用咪达唑仑与吗啡联合持续镇静的效果。 方法 选择2007年4月－2010年4月在重症医学科（ICU）进行有创机械通气的重症急性左心衰竭患者86例，随机均分为咪达唑仑组（A组）、咪达唑仑联合吗啡组（B组）。采用Ramsay镇静评分，使每例患者镇静水平达RamsayⅢ～Ⅳ级。观察起效时间、镇静时间、停药后苏醒时间和停药后拔管时间；监测镇静12 h后的血气分析及血流动力学参数的变化。 结果 B组起效时间、镇静时间、停药后苏醒时间和停药后拔管时间明显短于A组（P＜0.05）。且镇静12 h后B组血气分析及血流动力学较A组明显改善（P＜0.05）。 结论 重症急性左心衰竭患者机械通气时使用咪达唑仑联合吗啡镇静能达到满意镇静效果，同时改善重症急性左心衰竭患者的低氧血症和高碳酸血症。
目的 研究地佐辛＋咪达唑仑在大隐静脉射频闭合术中的镇静作用，并观察其对生命体征的影响以及不良反应的发生情况。方法 选取60例行大隐静脉射频闭合术患者，根据麻醉方式分为芬太尼＋咪达唑仑组和地佐辛＋咪达唑仑组２组，每组30例。分别监测心率（HR）、动脉血氧饱和度（SpO2）、平均动脉压（MAP），记录用药后5min和30min的镇静评分、生命体征以及术中不良反应的发生情况。结果 给药后5min和30min的镇静效果评分芬太尼＋咪达唑仑组分别为（2.95±0.14）分和（4.09±0.05）分，地佐辛＋咪达唑仑组分别为（3.16±0.09）分和（4.08±0.08）分，2组比较差异无统计学意义（P＞0.05）。2组给药后5min和30min的HR、SpO2及MAP比较差异均无统计学意义（P＞0.05）；与给药前（0min）比较，差异也无统计学意义（P＞0.05）。2组患者镇静良好，无躁动，均无一例发生呼吸抑制，仅芬太尼＋咪达唑仑组有4例发生呛咳。结论 芬太尼和地佐辛联合咪达唑仑用于大隐静脉射频消融手术患者，镇静效果良好，对生命体征影响小，但地佐辛组无呛咳，不良反应发生率更低。
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
Objective To study the sedative effects and safety of dexmedetomidine and midazolamfor acute exacerbate of chronic obstructive pulmonary disease ( AECOPD) underwentmechanical ventilation.Methods 68 AECOPD patients underwentmechanical ventilation were enrolled and randomly divided into adexmedetomidine group ( n =34) and a midazolam group ( n = 34) by acute physiology and chronic healthevaluation Ⅱ ( APACHEⅡ) score. The patients in the dexmedetomidine group were given a loading dose( 1 μg/kg) and then maintained with 0. 2-0. 8 mg·kg- 1 ·h- 1 . The patients in the midazolam group weregiven a loading dose ( 0. 05 mg/kg) and then maintained with 0. 06-0. 2 mg· kg- 1 · h- 1 . Sedation levelwas assessed by Ramsay score and maintained a Ramsay score of 3-4. The sedation onset time, disablesedatives wake time, duration of mechanical ventilation, extubation success rate, ICU length of stay, and 28days mortality after admission to the ICU were compared between two groups. And calmer respiratorydepression, circulatory and delirium adverse reactions incidence were also compared. Results Thedifferences in patients’age, gender, and APACHEⅡ score between two groups were not significant ( P gt;0. 05) . Compared with the midazolam group, the dexmedetomidine group had more rapid onset of sedation[ ( 49. 80 ±8. 20) s vs. ( 107. 55 ±19. 65) s, P lt;0. 01] , shorter wake-up time [ ( 18. 90 ±2. 30) min vs. ( 40. 82 ±19. 85) min, P lt;0. 01] , shorter duration of mechanical ventilation [ ( 4. 9 ±1. 6) d vs. ( 7. 8 ±2. 5) d,P lt;0. 01] , higher successful extubation rate ( 79. 41% vs. 58. 82% , P lt;0. 01) , and shorter ICUlength of stay[ ( 6. 5 ±2. 5) d vs. ( 9. 6 ±3. 4) d, P lt;0. 05] . Dexmedetomidine had lower respiratory depression rate, littleeffects on hemodynamics, lower occurrence and short duration of delirium. Conclusion It is highlyrecommended that dexmedetomidine be used for sedation in AECOPD patients with mechanical ventilation.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
ObjectiveTo evaluate the clinical effects of nebulized lidocaine anesthesia and anesthesia with lidocaine and midazolam in patients with preoperative bronchoscopy. MethodsTotally, 136 inpatients between May 2002 and June 2013 with preoperative bronchoscopy were included in the study. The patients were randomly assigned to experimental group and control group with 68 patients in each. For patients in the experimental group, 8 mL of 2% lidocaine was administered through inhalation anesthesia, followed by 2-3 mg bolus of midazolam, and subsequently 0.5 mg of midazolam was administered every 2 minutes depending on patients' awareness. Patients in the control group accepted lidocaine alone for anesthesia. The clinical efficacy and adverse effects of both the two ways of anesthesia were observed. ResultsThe time of sustained and effective anesthesia was (24.5±2.8) minutes in the experimental group, as compared with (16.8±2.1) minutes in the control group (P<0.01). The average amount of consumption of lidocaine was (12.4±1.3) mL in the experimental group, as compared with (16.8±1.5) mL in the control group (P<0.01). The heart rate at 5 min after operation was (81.5±19.5) beats/min in the experimental group, as compared with (94.6±34.6) beats/min in the control group (P<0.01). The mean pulse oxygen saturation at 5 min after operation was (93.5±3.6)% in the experimental group, as compared with (88.2±13.3)% in the control group (P<0.01). ConclusionCombined application of lidocaine and midazolam before bronchoscopy is simple and feasible for anesthesia, which has higher success rate, lesser side effects and other reactions such as body movement and coughing.
ObjectiveTo explore sedation effect of dexmedetomidine alone and its effects on respiration and circulation of complications in transtracheal endoscopic interventional therapy. MethodsFrom April 2012 to May 2014, 60 adult patients who plan to undergo transtracheal endoscopic interventional therapy were recruited in the study. The patients were divided into a midazolam combined with fenanyl citrate intravenous injection group (MF group), and a dexmedetomidine target controlled infusion group (Y group) using the method of random number table, with 30 cases in each group. All patients were given 2% lidocaine 15 mL by ultrasonic atomizing inhalation for local surface anaesthesia preoperatively, and then the patients in MF group received midazolam and fentanyl citrate by slow intravenous injection, the patients in Y group received dexmedetomidine 0.5 g intravenous injection and persistant infusion of dexmedetomidinein dosage of 0.2 μg/h. The basic Ramsay sedation score (T0) was recorded, then the Ramsay sedation scoring was conducted when the bronchoscope entering into the pharyngeal cavity (T1), into the glottis (T2), and into the bronchial (T3), respectively. ResultsThere were no significant differences in restlessness, hypotension, hypertension, or tachycardia incidence rate between two groups (P>0.05). The differences in Ramsay score between two groups was not significant at T0 or T1 time point (P>0.05), but was significant at T2 and T3 time point (P<0.05). Compared with MF group, the incidence of respiratory depression and hypoxemia was significantly lower, and the recovery time was significantly shorter in Y group (P<0.05). All patients in Y group woke up immediately by simple call. While in MF group, 23 patients needed intravenous flumazenil to promote awakening. ConclusionDexmedetomidine alone can provide effective sedation in transtracheal endoscopic interventional therapy with good effect, high safety, and more convenient awakening.