| Objective: In order to apply more effective treatment in elderly patients with acute heart failure,Comparative study on mechanical ventilation treating elderly patients with acute heart failure,combined with midazolam alone or morphine and midazolam.The results may provide meaningful clinical evidence.Methods: Medical records were collected from 33 cases of elderly patients with acute cardiogenic pulmonary edema at the Peoples Hospital of Yu Huan County between January 2007 and January 2017.Complicated by respiratory failure or pulmonary edema,these patients were admitted to the emergency department and ICU,and all received mechanical ventilation.According to the different treatment about sedation,patients were divided into two groups: the midazolam alone group of 18 cases(group M),and midazolam combined with morphine group of 15 cases(group M+M).All patients were received goal-directed sedative treatment after tracheal intubation and mechanical ventilation.Sedation effect was assessed with Riker sedation-agitation scale(SAS),with the goals of sedation score level of 3~4,repeated every 2 hours.Based on routine anti-heart failure therapy,Group M was given midazolam 1mg every 30 seconds for sedation till SAS score was 3 to 4,thereafter on midazolam infusion modulated by SAS score.Group M+M was given one bolus of morphine 0.05 mg/kg thereafter on morphine 5-20 ug/kg/h infusion combined with midazolam till SAS score was 3 to 4.Heart rate(HR),mean arterial pressure(MAP),ventilation parameters,B-type natriuretic peptide(BNP)and arterial blood gas analysis according to the heart failure conditions were all recorded on mechanical ventilation immediately and 6h,24 h after mechanical ventilation,as well as sedation score,consumption of sedation and analgesics,awake time after medicine stopped,time of mechanical ventilation,and duration in ICU time.SPSS15.0 was used to compare two groups.Results : 1.The HR,MAP,respiratory rate(RR),partial pressure of carbon dioxide(Pco2)and lactate level significantly decreased after mechanical ventilation treatment for 6 hours in both two groups(P<0.05).The p H value and oxygenation index also improved significantly(P<0.05).Meanwhile,in group M+M,a significant decrease of the peak inspiratory pressure(PIP)was observed after the mechanical ventilation for 6 hours(P<0.05).Compared with that at 6hours of mechanical ventilation treatment,the oxygenation index increased significantly while PIP and positive end expiratory pressure(PEEP)decreased significantly at 24 hours of treatment in two groups(P<0.05).And the serum BNP was significantly lower at 24 hours of treatment than that before treatment in two groups(P<0.05).2.Comparison between the two groups after mechanical ventilation for 6 h,the PIP? RR and HR of the group M+M were lower than group M,and the lactate clearance rate(LCR)of group M+M was higher than that of group M(P<0.05).After 24 hours of application of mechanical ventilation,the HR and PIP of the group M+M were lower than group M,meanwhile the oxygenation index was higher than the group M(P<0.05).3.To compare the sedative effect between the two groups.The proportion of sedation goal-achieving of the group M+M was higher than group M,and the average hourly Midazolam consumption,consumption of sedation and analgesics,and awake time after medicine stopped were lower than the group M(P<0.05).4.There was no statistically difference(P>0.05)in the incidence of low blood pressure during the sedative period,time of mechanical ventilation,and the duration in ICU time between the two groups.Conclusions: 1.the treatment of mechanical ventilation under target sedation for elderly heart failure complicated with pulmonary edema is explicit.2.By using morphine with midazolam for analgesic sedative treatment,it reduces the dosage of midazolam and treatment fees,and leads to better sedative effect.Meanwhile,there is no increase of possibilities of having hypotension complication. |
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