中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
9期
543-546
,共4页
万林骏%黄青青%岳锦熙%林岚%李思宏
萬林駿%黃青青%嶽錦熙%林嵐%李思宏
만림준%황청청%악금희%림람%리사굉
右美托咪定%咪达唑仑%镇静%副作用%外科重症监护病房%机械通气
右美託咪定%咪達唑崙%鎮靜%副作用%外科重癥鑑護病房%機械通氣
우미탁미정%미체서륜%진정%부작용%외과중증감호병방%궤계통기
Dexmedetomidine%Midazolam%Sedation%Side-effect%Surgical intensive care unit%Mechanical ventilation
目的 研究右美托咪定和咪达唑仑用于外科重症监护病房(SICU)术后机械通气(MV)患者的镇静效果及安全性。方法 选择术后带气管导管人SICU行呼吸机辅助通气患者200例，按随机数字表法分为两组，分别给予咪达唑仑（98例）和右美托咪定(102例)镇静治疗，两组均常规给予芬太尼持续静脉泵入镇痛，根据Prince-Henry镇痛评分调整芬太尼剂量，使疼痛评分维持在1～2分；根据Riker镇静和躁动评分(SAS)调整镇静药剂量，使镇静深度评分控制在2～4分；连续监测记录呼吸机参数、心电图、心率、血压、呼吸、脉搏血氧饱和度，并进行血气分析。观察记录两组药物用量，MV时间，以及低血压、心动过缓、谵妄、恶心等副作用发生率。结果 右美托咪定与咪达唑仑均能使患者达到镇静及镇痛目标评分，右美托咪定组更易唤醒并保持安静。与咪达唑仑组比较，右美托咪定组芬太尼用量(μg．kg-1· h-1)明显减少（0.23±0.13比0.41±0.12，P＜0.01），MV时间(h)明显缩短(7.20±6.29比12.44±8.96，P＜0.01)，低血压发生率(27.45％比11.22％)和心动过缓发生率(24.51％比10.20％)明显升高(均P＜0.05)，谵妄发生率明显降低（3.92％比31.63％，P＜0.01），恶心发生率降低(9.80％比11.22％，P＞0.05)。将右美托咪啶组按是否发生低血压再分为两个亚组分析：低血压与非低血压组间术中失血量(ml/kg)、术中输液量(ml．kg-1．h-1)、术后当日及术后1d血乳酸含量(mmol/L)比较差异无统计学意义（术中失血量：12.79±12.13比13.52±11.62；术中输液量：11.91±4.59比13.09±7.05;术后当日乳酸含量：1.88±1.07比1.71±0.87，术后1d乳酸含量：1.43±0.98比1.37±0.79，均P＞0.05）。结论 右美托咪定用于外科术后MV患者镇静效果满意，易唤醒，谵妄发生率低，可缩短MV时间，减少芬太尼用量约50％，是一种较为理想的SICU镇静剂。但要加强用药期间的监测，防治低血压和心动过缓。
目的 研究右美託咪定和咪達唑崙用于外科重癥鑑護病房(SICU)術後機械通氣(MV)患者的鎮靜效果及安全性。方法 選擇術後帶氣管導管人SICU行呼吸機輔助通氣患者200例，按隨機數字錶法分為兩組，分彆給予咪達唑崙（98例）和右美託咪定(102例)鎮靜治療，兩組均常規給予芬太尼持續靜脈泵入鎮痛，根據Prince-Henry鎮痛評分調整芬太尼劑量，使疼痛評分維持在1～2分；根據Riker鎮靜和躁動評分(SAS)調整鎮靜藥劑量，使鎮靜深度評分控製在2～4分；連續鑑測記錄呼吸機參數、心電圖、心率、血壓、呼吸、脈搏血氧飽和度，併進行血氣分析。觀察記錄兩組藥物用量，MV時間，以及低血壓、心動過緩、譫妄、噁心等副作用髮生率。結果 右美託咪定與咪達唑崙均能使患者達到鎮靜及鎮痛目標評分，右美託咪定組更易喚醒併保持安靜。與咪達唑崙組比較，右美託咪定組芬太尼用量(μg．kg-1· h-1)明顯減少（0.23±0.13比0.41±0.12，P＜0.01），MV時間(h)明顯縮短(7.20±6.29比12.44±8.96，P＜0.01)，低血壓髮生率(27.45％比11.22％)和心動過緩髮生率(24.51％比10.20％)明顯升高(均P＜0.05)，譫妄髮生率明顯降低（3.92％比31.63％，P＜0.01），噁心髮生率降低(9.80％比11.22％，P＞0.05)。將右美託咪啶組按是否髮生低血壓再分為兩箇亞組分析：低血壓與非低血壓組間術中失血量(ml/kg)、術中輸液量(ml．kg-1．h-1)、術後噹日及術後1d血乳痠含量(mmol/L)比較差異無統計學意義（術中失血量：12.79±12.13比13.52±11.62；術中輸液量：11.91±4.59比13.09±7.05;術後噹日乳痠含量：1.88±1.07比1.71±0.87，術後1d乳痠含量：1.43±0.98比1.37±0.79，均P＞0.05）。結論 右美託咪定用于外科術後MV患者鎮靜效果滿意，易喚醒，譫妄髮生率低，可縮短MV時間，減少芬太尼用量約50％，是一種較為理想的SICU鎮靜劑。但要加彊用藥期間的鑑測，防治低血壓和心動過緩。
목적 연구우미탁미정화미체서륜용우외과중증감호병방(SICU)술후궤계통기(MV)환자적진정효과급안전성。방법 선택술후대기관도관인SICU행호흡궤보조통기환자200례，안수궤수자표법분위량조，분별급여미체서륜（98례）화우미탁미정(102례)진정치료，량조균상규급여분태니지속정맥빙입진통，근거Prince-Henry진통평분조정분태니제량，사동통평분유지재1～2분；근거Riker진정화조동평분(SAS)조정진정약제량，사진정심도평분공제재2～4분；련속감측기록호흡궤삼수、심전도、심솔、혈압、호흡、맥박혈양포화도，병진행혈기분석。관찰기록량조약물용량，MV시간，이급저혈압、심동과완、섬망、악심등부작용발생솔。결과 우미탁미정여미체서륜균능사환자체도진정급진통목표평분，우미탁미정조경역환성병보지안정。여미체서륜조비교，우미탁미정조분태니용량(μg．kg-1· h-1)명현감소（0.23±0.13비0.41±0.12，P＜0.01），MV시간(h)명현축단(7.20±6.29비12.44±8.96，P＜0.01)，저혈압발생솔(27.45％비11.22％)화심동과완발생솔(24.51％비10.20％)명현승고(균P＜0.05)，섬망발생솔명현강저（3.92％비31.63％，P＜0.01），악심발생솔강저(9.80％비11.22％，P＞0.05)。장우미탁미정조안시부발생저혈압재분위량개아조분석：저혈압여비저혈압조간술중실혈량(ml/kg)、술중수액량(ml．kg-1．h-1)、술후당일급술후1d혈유산함량(mmol/L)비교차이무통계학의의（술중실혈량：12.79±12.13비13.52±11.62；술중수액량：11.91±4.59비13.09±7.05;술후당일유산함량：1.88±1.07비1.71±0.87，술후1d유산함량：1.43±0.98비1.37±0.79，균P＞0.05）。결론 우미탁미정용우외과술후MV환자진정효과만의，역환성，섬망발생솔저，가축단MV시간，감소분태니용량약50％，시일충교위이상적SICU진정제。단요가강용약기간적감측，방치저혈압화심동과완。
Objective To study sedative effect and safety of dexmedetomidine and midazolam for post-operative patients undergoing mechanical ventilation (MV) in surgical intensive care unit (SICU).Methods Two hundred cases of post-operative patients undergoing MV with tracheal intubation in SICU were enrolled and divided into two groups by random numerical table method. They were treated either with midazolam (98 cases) or dexmedetomidine (102 cases). In both groups fentanyl was given intravenously continually for analgesia. The amount of fentanyl was adjusted according to Prince-Henry analgesic score to keep on 1 - 2 analgesic score; the dose of sedation was regulated by Riker sedative and restless score (SAS) maintain 2 - 4 sedative score. During the course, parameters of the ventilator, electrocardiogram, heart rate (HR), blood pressure, respiratory rate, pulse oxygen saturation (SpO2), blood gas analysis were observed and registered continuously. The amount of the drug, duration of MV, and incidence of side-effects such as hypotension, bradycardia, delirium, nausea, etc. were recorded in two groups. Results In all the patients in two groups taking dexmedetomidine or midazolam expected sedative and analgesia scores were obtained. In the group with dexmedetomidine, the patients were aroused easier with adequate sedation, and when compared with the group with midazolam, dose of fentanyl (μg · kg-1 · h-1) was significantly smaller (0. 23± 0. 13 vs. 0. 41 ± 0. 12, P ＜ 0. 01 ), duration of MV (hours) was clearly shorter (7.20 ± 6.29 vs.12. 44±8. 96, P＜0. 01), the rates of hypotension (27. 45％ vs. 11.22％) and bradycardia (24.51％ vs.10. 20％) were significantly higher (both P＜0. 05), the rate of delirium was clearly lower (3. 92％ vs.31.63％, P＜0. 01), the rate of nausea showed a slight decrease (9.80％ vs. 11.22％, P＞0. 05). Thepatients in the group with dexmedetomidine were divided into two subgroups of hypotension and non-hypotension. The quantity of blood loss during operation (ml/kg), amount of fluid infusion during operation (ml · kg-1 · h-1), blood lactic acid concentration (mmol/L) on the day of surgical operation and the 1st day post-operative showed no significant difference between these subgroups (quantity of blood loss on the day of surgical operation: 12.79± 12. 13 vs. 13. 52± 11.62; amount of fluid infusion during surgical operation: 11.91 ± 4.59 vs. 13. 09 ± 7.05 ;blood lactic acid concentration on the day of operation: 1.88 ± 1.07vs. 1.71± 0. 87, blood lactic acid concentration on the 1st day post-operative : 1.43± 0. 98 vs. 1.37± 0. 79,all P＞0. 05). Conclusion Sedative effect of dexmedetomidine is satisfactory for patients undergoing MV after operation, with the property of easier arousal, lower delirium rate, and it helps to shorten the duration of MV with reduction the dosage of fentanyl by 50％. However, it is necessary to enhance observation in order to prevent and control hypotension and bradycardia.
