Sanchez-Izquierdo-Riera J A, Caballero-Cubedo R E, Perez-Vela J L, Ambros-Checa A, Cantalapiedra-Santiago J A, Alted-Lopez E
Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain.
Anesth Analg. 1998 Jun;86(6):1219-24. doi: 10.1097/00000539-199806000-00016.
Previous studies have compared sedation profiles with midazolam (Mz) and propofol (Pf), particularly in heterogeneous populations of patients. Decreases in blood pressure and heart rate have been reported after the administration of propofol. These side effects are potentially deleterious in severe trauma patients, particularly in patients with head trauma. To assess the safety and efficacy of Mz and Pf, alone or in combination, in the prolonged sedation of severe trauma patients, we designed a prospective, controlled, randomized, study. One hundred consecutively admitted trauma patients requiring mechanical ventilation and sedation for more than 48 h were studied. Patients were sedated according to three different protocols based on the continuous i.v. administration of Mz alone, Pf alone, and Mz in combination with Pf. All patients received morphine chloride. Safety and efficacy were assessed during the sedation and wake-up periods according to clinical and laboratory variables. Cerebral hemodynamics were also studied in patients with head trauma. Patients were sedated for 6.3 +/- 4.0 days (mean +/- SD). All three sedation regimens were equally efficacious in achieving the desired sedation goal. The incidence of adverse events during the sedation period was also similar. In head trauma patients with intracranial pressure (ICP) monitoring, we did not find differences in ICP, cerebral perfusion pressure, or jugular venous oxygen saturation among the three groups. The serum triglyceride concentration was significantly higher in the Pf group. Wake-up time was significantly shorter in the Pf group. We conclude that both Mz and Pf are safe and efficacious in the sedation of severe trauma patients. The use of Pf in these patients is associated with a high incidence of hypertriglyceridemia and a shorter wake-up time.
In a prospective, controlled, randomized study, we confirmed the safety and efficacy of midazolam and propofol, alone or in combination, in the prolonged sedation of a homogeneous group of severe trauma patients, particularly in patients with head trauma. The propofol group had shorter wake-up times and higher triglyceride levels.
既往研究比较了咪达唑仑（Mz）和丙泊酚（Pf）的镇静情况，尤其是在异质性患者群体中。据报道，丙泊酚给药后会出现血压和心率下降。这些副作用在严重创伤患者中可能具有潜在危害，尤其是头部创伤患者。为评估Mz和Pf单独或联合用于严重创伤患者长时间镇静的安全性和有效性，我们设计了一项前瞻性、对照、随机研究。对连续收治的100例需要机械通气和镇静超过48小时的创伤患者进行了研究。根据三种不同方案对患者进行镇静，分别是持续静脉输注单独的Mz、单独的Pf以及Mz与Pf联合使用。所有患者均接受了吗啡。根据临床和实验室变量在镇静期和苏醒期评估安全性和有效性。还对头部创伤患者的脑血流动力学进行了研究。患者镇静时间为6.3±4.0天（均值±标准差）。所有三种镇静方案在实现预期镇静目标方面同样有效。镇静期间不良事件的发生率也相似。在进行颅内压（ICP）监测的头部创伤患者中，我们未发现三组之间在ICP、脑灌注压或颈静脉血氧饱和度方面存在差异。Pf组的血清甘油三酯浓度显著更高。Pf组的苏醒时间显著更短。我们得出结论，Mz和Pf在严重创伤患者的镇静中均安全有效。在这些患者中使用Pf与高甘油三酯血症的高发生率和较短的苏醒时间相关。
在一项前瞻性、对照、随机研究中，我们证实了咪达唑仑和丙泊酚单独或联合用于一组同质的严重创伤患者（尤其是头部创伤患者）长时间镇静的安全性和有效性。丙泊酚组的苏醒时间更短，甘油三酯水平更高。
