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目的探讨喷他佐辛联合咪达唑仑对于急性呼吸窘迫综合征(ARDS)机械通气患者呼吸力学及血流动力学的影响。方法将100例ARDS患者随机平均分为2组,即咪达唑仑组(对照组,50例)和咪达唑仑+喷他佐辛组(治疗组,50例)。在治疗前和治疗24 h后对患者血流动力学指标(心率、平均动脉压、收缩压和舒张压),呼吸力学指标(呼吸频率、气道峰压和肺顺应性),血气分析指标(氧饱和度和氧合指数)以及氧化应激指标(血中超氧化物歧化酶和血中丙二醛)进行观察。结果治疗24 h后2组患者心率、平均动脉压、收缩压和舒张压均较治疗前下降(P均<0.05),但2组患者间各指标差异无统计学意义(P均>0.05)。在治疗24 h后,2组患者血氧饱和度(Sa O2)、氧合指数(Pa O2/Fi O2)、呼吸频率(RR)、吸气峰压(PIP)、肺动态顺应性(Crs)均较治疗前均有明显改善(P均<0.05);且治疗组较对照组改善更加显著(P均<0.05)。在治疗24 h后,2组患者血丙二醛(MDA)水平较治疗前明显升高,血超氧化物歧化酶(SOD)活性较治疗前明显下降(P均<0.05);与治疗组相比较,对照组患者血中MDA水平和SOD活性变化更显著(P<0.05)。在治疗过程中未出现与咪达唑仑和喷他佐辛相关的严重的不良反应。结论本研究发现咪达唑仑联合喷他佐辛进行镇静和镇痛,可以更加有效的改善ARDS患者氧合功能和肺顺应性以及抑制氧化应激反应。同时表明在ARDS患者有创机械通气过程中喷他佐辛和咪达唑仑有协同作用,且安全有效。
Objective To investigate the effects of pentazocine and midazolam on respiratory mechanics and hemodynamics in patients with acute respiratory distress syndrome (ARDS). Methods One hundred patients with ARDS were randomly divided into 2 groups: midazolam group (control group, 50 cases) and midazolam + pentazocine group (50 cases). Hemodynamic parameters (heart rate, mean arterial pressure, systolic and diastolic blood pressure), respiratory mechanics (respiratory rate, peak airway pressure and lung compliance), blood gas analysis (before and 24 h after treatment) Oxygen saturation and oxygenation index) and oxidative stress indicators (blood superoxide dismutase and blood malondialdehyde) were observed. Results After 24 hours of treatment, heart rate, mean arterial pressure, systolic pressure and diastolic blood pressure decreased in both groups (all P <0.05), but there was no significant difference between the two groups (P> 0.05). After 24 h of treatment, the blood oxygen saturation (Sa O2), oxygenation index (Pa O2 / Fi O2), respiratory rate (RR), peak inspiratory pressure (PIP) and pulmonary dynamic compliance (Crs) (P <0.05), and the treatment group improved more significantly than the control group (all P <0.05). After 24 h of treatment, the levels of malondialdehyde (MDA) in the two groups were significantly higher than those before treatment, and the activity of superoxide dismutase (SOD) was significantly lower than that before treatment (all P <0.05) In comparison, the changes of MDA level and SOD activity in the control group were more significant (P <0.05). No serious adverse reactions associated with midazolam and pentazocine occurred during the course of treatment. Conclusion This study found that midazolam combined with pentazocine for sedation and analgesia can be more effective in improving oxygenation and lung compliance ARDS patients and inhibition of oxidative stress response. At the same time, it is indicated that pentazocine and midazolam have a synergistic effect in the safe mechanical ventilation of patients with ARDS and are safe and effective.