摘要
目的 研究右美托咪啶对重症患者的镇静、镇痛作用以及对机体的影响.方法 将2009年6月至2010年5月本院重症监护病房（ICU）收治的需要镇静、镇痛的73例患者按照随机原则分为右美托咪啶组（35例）和咪达唑仑组（38例）.右美托咪啶组经静脉泵入负荷剂量的右美托咪啶1μg/kg、10 min,继以0.2～0.7μg·kg-1·h-1维持;咪达唑仑组给予负荷剂量咪达唑仑0.06 mg/kg,再以0.04～0.20 mg·kg-1·h-1维持.比较两组患者疼痛情况、机械通气时间、顺行性遗忘情况、唤醒时间、血氧饱和度、血压和心率等变化.结果 两组患者年龄、性别及急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分比较差异均无统计学意义.通过调整药物剂量使两组患者Ramsay评分均在2～4分时,右美托咪啶组视觉模拟法（VAS）评分低于咪达唑仑组[（2.38±0.48）分比（6.07±0.79）分,P＜0.01];唤醒所需时间显著短于咪达唑仑组[（0.17±0.03）h比（1.63±0.56）h,P＜0.01].右美托咪啶组有2例出现血压下降,自主呼吸频率无明显变化;咪达唑仑组有7例出现血压下降,2例出现自主呼吸频率下降（P＜0.05）.右美托咪啶组中有4例产生顺行性遗忘;咪达唑仑组所有患者均产生顺行性遗忘（P＜0.05）.右美托咪啶组和咪达唑仑组患者机械通气时间比较差异无统计学意义[（5.16±1.68）h比（5.21±1.56）h,P＞0.05].结论 右美托咪啶可作为ICU镇静、镇痛的首选药物.
Objective To investigate the sedative and analgesic effects of dexmedetomidine in serious patients. Methods Seventy-three patients admitted to the intensive care unit （ICU） from June 2009 to May 2010 were in need of sedation and analgesia. They were randomly divided into dexmedetomidine group （n=35） and midazolam group （n=38）. Patients in dexmedetomidine group were given a loading dose （1μg/kg） for 10 minutes and then maintained with 0.2 - 0.7μg·kg-1·h-1. Patients in midazolam group were given a loading dose （0.06 mg/kg） and then maintained with 0.04 - 0.20 mg·kg-1·h-1. Pain symptom, length of mechanical ventilation, incidence of anterograde amnesia and awakening time, and changes in blood pressure （BP） and heart rate （HR） were compared between the two groups. Results There was no significant difference in gender proportion, age, or acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score between the two groups. The score of visual analog scale in dexmedetomidine group was lower than that in midazolam group （2.38±0.48 vs. 6.07 ±0. 79, P〈0.01）when intake dose was adjusted to maintain the Ramsay score of 2 - 4. The awakening time was shorter in dexmedetomidine group than that in midazolam group [（0.17 ± 0.03） hours vs. （1.63 ± 0.56） hours,P〈0.01]. BP was lowered in 2 patients with no significant change in respiration rate in dexmedetomidine group, while BP was lowered in 7 patients with reduced respiration rate in 2 patients in midazolam group （P〈0.05）. All patients in midazolam group, in contrast with 4 patients in dexmedetomidine group, had anterograde amnesia （P〈0.05）. There was no significant difference in length of machanical ventilation between dexmedetomidine group and midazolam group [（5.16 ± 1.68） hours vs. （5.21 ± 1.56） hours,P〉0.05]. Conclusion Dexmedetomidine is the recommended drug used for sedation and analgesia in ICU.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2010年第10期632-634,共3页
Chinese Critical Care Medicine
