目的: 观察对比在老年重症脑出血机械通气患者中应用咪达唑仑与丙泊酚复合瑞芬太尼方案的镇静效果。方法: 收集2023年1月至2025年2月龙南市第一人民医院接收的符合纳排标准的老年重症脑出血机械通气患者75,根据不同镇静药物的使用分为观察组（40例）和对照组（35例）。两组均以瑞芬太尼镇痛,在此基础上对照组患者给予咪达唑仑镇静处理,观察组采取丙泊酚镇静处理。比较分析两组用药后不同时间点的镇静效果、血流动力学指标、血气指标以及呼吸机相关性肺炎发生率、不良反应发生率。结果: 两组患者不同时间点（用药后2、8、24、48 h）的行为疼痛量表（behavioral pain scale,BPS）评分、Richmond躁动-镇静量表（Richmond agitation-sedation scale,RASS）评分无明显差异;观察组不同时间点（用药后2、8、24、48 h）心率均低于对照组;两组不同时间点（用药后2、8、24、48 h）收缩压无明显差异,观察组24 、48 h舒张压无明显差异,观察组2、8 h的舒张压低于对照组;两组呼吸机相关性肺炎、呕吐发生率无明显差异,观察组心动过缓、低血压发生率较对照组高。结论: 咪达唑仑与丙泊酚都能达到老年重症脑出血机械通气患者的镇静要求,咪达唑仑组对患者血气指标及血流动力学影响较小,总不良不应发生率低,对于老年重症脑出血机械通气患者是一种理想的镇静模式。

Objective To observe the sedative effects of Midazolam combined with Remifentanil versus Propofol combined with Remifentanil in elderly patients with severe cerebral hemorrhage undergoing mechanical ventilation. Methods A total of 75 elderly patients with severe intracerebral hemorrhage who met the inclusion and exclusion criteria and were admitted to Longnan City First People's Hospital from January 2023 to February 2025 were collected. They were divided into an observation group (40 cases) and a control group (35 cases) based on the use of different sedative drugs. Both groups received Remifentanil for analgesia. On this basis, the control group patients received Midazolam for sedation, while the observation group received Propofol for sedation. The sedative effect, hemodynamic indicators, blood gas indicators at different time points after medication, the incidence of ventilator-associated pneumonia, and the incidence of adverse reactions between the two groups were compared and analyzed. Results There was no significant difference in the Behavioral Pain Scale (BPS) scores and Richmond Agitation-Sedation Scale (RASS) scores between the two groups at different time points (2, 8, 24, and 48 hours after medication). The heart rate of the observation group was lower than that of the control group at all time points. There was no significant difference in systolic blood pressure between the two groups at different time points, and no significant difference in diastolic blood pressure in the observation group at 24 and 48 hours; however, the diastolic blood pressure in the observation group at 2 and 8 hours was lower than that of the control group. There was no significant difference in the incidence of ventilator-associated pneumonia and vomiting between the two groups, but the incidence of bradycardia and hypotension was higher in the observation group than in the control group. Conclusion Both midazolam and propofol can meet the sedation requirements of elderly patients with severe cerebral hemorrhage undergoing mechanical ventilation. The midazolam group has little effect on blood gas indicators and hemodynamics, and the overall incidence of adverse events should not be low. It is an ideal sedation mode for elderly patients with severe cerebral hemorrhage undergoing mechanical ventilation.