Comparision Investigation Of Sedation Effect With Propofol And Midazolam On Mechanically Ventilated Patients In ICU

Objective:To observe the safety and the effect of sedation on mechanically ventilated patients in ICU with propofol and midazolam To contrast the effect of sedation, to search the best way of sedation for mechanically ventilated patients in ICU.Methods:All cases are from ICU of Yanbian university affililated hospital, chest trauma necessary mechanical ventilation and sedation forty cases.All patients are divided into group A (group propofol,n=20) and group B (groupmidazolam,n=20) randomly. Group A:male 15 cases, female 5 cases,45-65 years old; group B:male 13 cases, female 7 cases,42-67 years old. All the patients were normal liver and kidney function, no serious cardiac dysfunction. Group A:intravenous injection propofollmg/kg,inject time is 30-60s in order to reduce the hemodynamic effects, then inject continuous syringe pump with 1-5mg/kg/h;Group B:intravenous injection midazolam 0.06 mg/kg, then inject continuous syringe pump with 0.05-0.2 mg/kg/h. Consistently monitor the change of BP,HR,SPO2 and RR at each time back and forth sedation with Multi-function monitor. Evaluate the sedative effects according to Ramsay classification standard.Observe sedation onset time, satisfactory sedative effect time (Ramsay3-4 score), palinesthesia time after drug discontinuation, record side effects (such as nausea, vomiting, respiratory inhibition, hypotension etc.) occurred.Results:(1) The changes of two groups in BP,HR,RR,SPO2:the changes of BP and HR; compared with Group A and B, each time point BP and HR were significantly lower then group B after sedative, there was significant difference (P<0.05).BP and HR of the groups at each time point were obviously lower then before sedative, there was significant difference (P<0.05).the changes of SPO2 and R; compared with Group A and B, back and forth sedation, there was no significant difference(p>0.05). RR of the groups at each time point were significantly lower after sedation, there was significant difference (P<0.05).but compared with change of SPO2 before sedation, there was no significant difference(p>0.05). (2) The compared with group A and B about sedation onset time, satisfactory sedation effect time (Ramsay3-4 score), palinesthesia time after drug discontinuation:group A were shorter then group B, there was significant difference (P<0.05). (3) Compared ABGA before sedation,30min after sedation,30min after drug discontinuation of two groups: PaO2 and PaCO2 at each time point, there were no significant difference (p> 0.05). Compared in the group; 30min after sedation,30min after drug discontinuation of two groups,PaCO2 obviously higher than before sedation, there was significant difference (P<0.05), but the change of PaO2 was not significantly, there was no significant difference (P>0.05). (4) Compared with side effects:there were no significant difference about incidence of nausea and vomiting (P>0.05); The incidence of sleep again after drug discontinuation in group A was obviously lower then group B, there was significant difference (P<0.05); The incidence of hypotension after sedation in group A was significantly higher than group B,there was significant difference (P< 0.05).Conclusion:1. Propofol and midazolam used in mechanically ventilated patients in ICU, the effect of sedation is remarkable.2. Propofol take effect quickly, faster recovery.but has more influence hemodynamic changes, the incidence of hypotension is higer then midazolam, and the price is expensive; midazolam has a little influence about hemodynamie,has good amnestic effect,the price is cheap.