2024 年第 5 期 第 19 卷

瑞马唑仑与咪达唑仑应用于有创机械通气患者的镇静效果及对肺功能影响的比较研究

A comparative study on the sedative effect and pulmonary function impact of remazolam and midazolam in patients with invasive mechanical ventilation

作者：夏嘉鼎1 李龙鑫2

英文作者：Xia Jiading1 Li Longxin2

单位：1承德医学院附属医院重症医学科，承德067000；2河北省丰宁满族自治县医院重症医学科，承德068350

英文单位：1Department of Critical Care Medicine Affiliated Hospital of Chengde Medical University Chengde 067000 China; 2Department of Critical Care Medicine Fengning Manchu Autonomous County Hospital Hebei Province Chengde 068350 China

关键词：瑞马唑仑；咪达唑仑；有创机械通气；镇静效果；肺功能

英文关键词：Remazolam;Midazolam;Invasivemechanicalventilation;Sedationeffect;Pulmonaryfunction

• 摘要：

• 目的  探究瑞马唑仑与咪达唑仑应用于有创机械通气患者的镇静效果及对肺功能的影响。方法  选取2023年2—9月于承德医学院附属医院进行有创机械通气治疗的患者90例。采用随机数字表法将患者分为对照组（44例）和观察组（46例）。对照组在常规瑞芬太尼的基础上给予咪达唑仑镇静；观察组在常规瑞芬太尼的基础上给予甲苯磺酸瑞马唑仑镇静。比较2组的镇静程度、肺功能、血气分析指标、氧化应激和炎症反应指标及不良事件发生情况。结果  观察组给药后30 min及4、12、24 h时Richmond躁动-镇静评分均低于对照组［（-0.93±0.11）分比（-0.88±0.12）分、（-1.08±0.08）分比（-0.99±0.12）分、（-1.11±0.09）分比（-1.06±0.11）分、（-1.18±0.07）分比（-1.10±0.09）分］，差异均有统计学意义（均P<0.05）。镇静后，观察组平台压、心率、平均动脉压、丙二醛、白细胞介素6水平低于对照组，肺静态顺应性、脉搏血氧饱和度、超氧化物歧化酶水平高于对照组，差异均有统计学意义（均P<0.05）。观察组不良事件总发生率低于对照组，但差异无统计学意义（χ2=0.973，P=0.324）。结论  有创机械通气患者应用瑞马唑仑或咪达唑仑，能提高镇静效果，利于有创机械通气的推进和顺利进行，改善患者肺功能，减轻氧化应激和炎症反应状态，瑞马唑仑的麻醉镇静效果优于咪达唑仑。

• Objective  To explore the sedative effect of remazolam and midazolam on pulmonary function in patients with invasive mechanical ventilation. Methods  A total of 90 patients who underwent invasive mechanical ventilation in the Affiliated Hospital of Chengde Medical College from February to September 2023 were selected. The patients were divided into control group (44 cases) and observation group (46 cases) by random number table method. The control group was given midazolam for sedation on the basis of conventional remifentanil. The observation group was given remazolam tosilate for sedation on the basis of conventional remifentanil. The degree of sedation, pulmonary function, blood gas analysis indexes, oxidative stress and inflammatory response indexes, and adverse events were compared between the two groups. Results  The Richmond restlessness sedation scores in the observation group were lower than those in the control group at 30 min, 4 h, 12 h and 24 h after administration［(-0.93±0.11) vs (-0.88±0.12), (-1.08±0.08) vs (-0.99±0.12), (-1.11±0.09) vs (-1.06±0.11), and (-1.18±0.07) vs (-1.10±0.09)］(all P<0.05). After sedation, the platform pressure, heart rate, mean arterial pressure, levels of malondialdehyde, and interleukin-6 in the observation group were lower than those in the control group, and the pulmonary static compliance, pulse oxygen saturation, and superoxide dismutase levels were higher than those in the control group (all P<0.05). The total incidence of adverse events in the observation group was lower than that in the control group, but the difference was not statistically significant（χ2=0.973, P=0.324). Conclusion  The application of remazolam or midazolam in patients with invasive mechanical ventilation can improve the sedative effect, which is conducive to the promotion and smooth progress of invasive mechanical ventilation, improve the pulmonary function of patients, reduce oxidative stress and inflammatory response, and the anesthetic and sedative effect of remazolam is better than midazolam.