比較接受Midazolam及Propofol鎮靜之術後加護重症病患失憶程度與焦慮之緩解

Postoperative Sedation after Major Surgery with Midazolam or Propofol in the 1CU: Effects on Amnesia and Anxiety

背景：在重症加護病房中，propofol與midazolam是鎮靜藥物中最常被使用的藥物，以減緩患者因焦慮所造成的生理與心理不適反應。因此，本研究欲評估與比較手術後加護重症病患接受propofol和midazolam兩種藥物，造成之失憶程度與焦慮緩解成效。方法：共102位開完胸部、腹部或身體其他部位重大手術且需行鎮靜之成年患者，隨機分為給予propofol和midazolam 2組。患者在手術前評估其焦慮與失憶程度，停藥前再次評估其焦慮程度，停藥後30分鐘則評估其失憶程度。結果：這2組中，病患的基本資料並無顯著差異。Propofol與midazolam皆有造成失憶與緩解焦慮的效果，而midazolam的失憶效果顯著優於propofol （P< 0.001），至於在緩解焦慮的效果方面，兩種藥物則無統計上顯著差異（P = 0.189）。結論：Propofol與midazolam兩種鎮靜藥物，對加護病房重症患者皆能有效造成失憶與緩解焦慮的效果，而使用midazolam鎮靜藥物的加護重症病患，其失憶程度顯著優於使用propofol鎮靜藥物者。未來研究可合併使用藥效迅速之propofol與藥效相對較緩慢但失憶效果較佳的midazolam，對於減緩病患在加護病房的心理衝擊和不愉快的經驗可能有更好的成效。

Background: Propofol and midazolam are commonly used in the ICU to alleviate physical and psychological disturbances in consequence of anxiety. This study was conducted to assess and compare the impact of postoperative sedation after major surgery with midazolam or propofol on amnesia and anxiety in conscious patients under intensive care. Methods: One hundred and two adult patients irrespective of sex and age, receiving thoracic, abdominal or other major truncal surgery necessitating close care at the ICU, were randomly allocated into midazolam or propofol group. Prior to surgery, all patients were subjected to evaluation of the levels of anxiety and amnesia, which was repeated on the following morning with the level of anxiety and the level of amnesia assessed just before and 30 min after cessation of midazolam or propofol medication, respectively. Results: There were no significant differences between the two groups regarding gender, age, types of analgesics used, and anxiety. In both groups, the levels of anxiety (P < 0.001) and amnesia (P < 0.001) were improved significantly over the following day. Midazolam had more pronounced effects on amnesia than propofol (P < 0.001). There were no significant differences between the two groups in the pre- or post-drug anxiety (P = 0.189). Conclusions: Both midazolam and propofol are effective amnesic and anxiolytic drugs. Midazolam tends to have more favorable effects on amnesia. It is speculated that combination of propofol and midazolam may give better results for treating critically ill ICU patients, the confirmation of which necessitates further study.