上海医学
上海醫學
상해의학
SHANGHAI MEDICAL JOURNAL
2009年
11期
944-948
,共5页
殷文渊%邓羽霄%杜唯佳%李雯%王祥瑞
慇文淵%鄧羽霄%杜唯佳%李雯%王祥瑞
은문연%산우소%두유가%리문%왕상서
右旋美托咪啶%镇静%脑电图
右鏇美託咪啶%鎮靜%腦電圖
우선미탁미정%진정%뇌전도
Dexmedetomidine%Sedation%Electroencephalography
目的 研究右旋美托咪啶(Dex)的镇静效应和脑电变化.方法 选择手术后需气管插管机械通气镇静时间大于6 h的重症监护病房(ICU)患者30例,随机双盲分为Dex组(D组,输注Dex)和空白对照组(C组,输注0.9%氯化钠溶液).分两个阶段给药,先以6.0 μg·kg~(-1)·h~(-1)经静脉泵注射给药10 min,随后以0.4 μg·kg~(-1)·h~(-1)的速度维持给药,记录给药前(T_0)及持续输注后5 min(T_1)、10 min(T_2)、20 min(T_3)、30 min(T_4)的Ramsay镇静评分和脑电数据.结果 D组T_1～T_4时间点的Ramsay镇静评分均显著低于C组(P值均<0.01).能量光谱分析显示,D组T_1～T_4时间点的β波能量显著低于C组、δ波能量显著高于C组(P值分别<0.05、0.01),T_2～T_4时间点的θ波能量显著高于C组(P值均<0.05),两组间各时间点α波能量的差异均无统计学意义(P值均>0.05).D组T_2～T_4时间点的相对β波能量和相对α波能量显著低于C组(P值分别<0.01、0.05)、相对δ波能量显著高于C组(P值均<0.01),两组间各时间点相对θ波能量的差异均无统计学意义(P值均>0.05).D组T_1～T_4时间点的95%频谱边界频率(SEF)均显著低于C组(P值分别<0.01、0.05).相关分析结果显示,Ramsay镇静评分与95%SEF呈负相关(r=0.694,P<0.01).结论 Dex可以产生明显的镇静作用,会抑制人类脑电的高频率波段活动,增加低频率波段活动,95%SEF可以有效地监测Dex的镇静深度.
目的 研究右鏇美託咪啶(Dex)的鎮靜效應和腦電變化.方法 選擇手術後需氣管插管機械通氣鎮靜時間大于6 h的重癥鑑護病房(ICU)患者30例,隨機雙盲分為Dex組(D組,輸註Dex)和空白對照組(C組,輸註0.9%氯化鈉溶液).分兩箇階段給藥,先以6.0 μg·kg~(-1)·h~(-1)經靜脈泵註射給藥10 min,隨後以0.4 μg·kg~(-1)·h~(-1)的速度維持給藥,記錄給藥前(T_0)及持續輸註後5 min(T_1)、10 min(T_2)、20 min(T_3)、30 min(T_4)的Ramsay鎮靜評分和腦電數據.結果 D組T_1～T_4時間點的Ramsay鎮靜評分均顯著低于C組(P值均<0.01).能量光譜分析顯示,D組T_1～T_4時間點的β波能量顯著低于C組、δ波能量顯著高于C組(P值分彆<0.05、0.01),T_2～T_4時間點的θ波能量顯著高于C組(P值均<0.05),兩組間各時間點α波能量的差異均無統計學意義(P值均>0.05).D組T_2～T_4時間點的相對β波能量和相對α波能量顯著低于C組(P值分彆<0.01、0.05)、相對δ波能量顯著高于C組(P值均<0.01),兩組間各時間點相對θ波能量的差異均無統計學意義(P值均>0.05).D組T_1～T_4時間點的95%頻譜邊界頻率(SEF)均顯著低于C組(P值分彆<0.01、0.05).相關分析結果顯示,Ramsay鎮靜評分與95%SEF呈負相關(r=0.694,P<0.01).結論 Dex可以產生明顯的鎮靜作用,會抑製人類腦電的高頻率波段活動,增加低頻率波段活動,95%SEF可以有效地鑑測Dex的鎮靜深度.
목적 연구우선미탁미정(Dex)적진정효응화뇌전변화.방법 선택수술후수기관삽관궤계통기진정시간대우6 h적중증감호병방(ICU)환자30례,수궤쌍맹분위Dex조(D조,수주Dex)화공백대조조(C조,수주0.9%록화납용액).분량개계단급약,선이6.0 μg·kg~(-1)·h~(-1)경정맥빙주사급약10 min,수후이0.4 μg·kg~(-1)·h~(-1)적속도유지급약,기록급약전(T_0)급지속수주후5 min(T_1)、10 min(T_2)、20 min(T_3)、30 min(T_4)적Ramsay진정평분화뇌전수거.결과 D조T_1～T_4시간점적Ramsay진정평분균현저저우C조(P치균<0.01).능량광보분석현시,D조T_1～T_4시간점적β파능량현저저우C조、δ파능량현저고우C조(P치분별<0.05、0.01),T_2～T_4시간점적θ파능량현저고우C조(P치균<0.05),량조간각시간점α파능량적차이균무통계학의의(P치균>0.05).D조T_2～T_4시간점적상대β파능량화상대α파능량현저저우C조(P치분별<0.01、0.05)、상대δ파능량현저고우C조(P치균<0.01),량조간각시간점상대θ파능량적차이균무통계학의의(P치균>0.05).D조T_1～T_4시간점적95%빈보변계빈솔(SEF)균현저저우C조(P치분별<0.01、0.05).상관분석결과현시,Ramsay진정평분여95%SEF정부상관(r=0.694,P<0.01).결론 Dex가이산생명현적진정작용,회억제인류뇌전적고빈솔파단활동,증가저빈솔파단활동,95%SEF가이유효지감측Dex적진정심도.
Objective To investigate the sedation effects of dexmedetomidine(Dex)and its influence on the electroencephalographic activity of patients.Methods Thirty patients(American Society of Anesthesiologists Ⅰ-Ⅱ)who needed ventilation for over 6 hours after operation in the intensive care unit(ICU)were randomly divided into Dex group(group D,infusion of Dex,n=15)and control group(group C,infutsion of normal saline,n=15). The drugs were given by two stages: first injection at 6.0 μg·kg~(-1)·h~(-1) for 10 min, and ther maintained at 0.4 μg·kg~(-1)·h~(-1). We recorded the Ramsay sedation score and electroencephatography (EEG) data before administration(T_0)and 5 min(T_1),10 min(T_2),20 min(T_3),30 min(T_4)after continuous infusion.Results The Ramsay sedation scores of group D at T_1-T_4 were significantly decreased compared with those of Group C(P<0.0 1).Spectrum analysis showed that the powers of beta in group D from T_1-T_4 was decreased,while the powers of delte at T_1-T_4 and theta at T_2-T_4 was increased compared with that in group C(P<0.05 or 0.0 1).There was no significant difference in the powers of alpha between two groups.The relative powers of beta and alpha of group D at T_2-T_4 was significantly lower than those of group C(P<0.01 or 0.05),the relative delta powers was significantly higher than that of group C(P<0.01).There were no significant differences in the relative theta powers between the two groups at all time points(P>0.05).The 95% spectral edge frequencies (SEF)of group D at T_1-T_4 was significantly lower than those of group C after Dex infusion(P<0.05 or 0.01).Correlation analysis showed a negative correlation between the Ramsay score and 95% SEF on(r=-0.694,P<0.01).Conclusion Dex has obvious sedative effect it can inhibit the high-frequency band of human brain electric activity and promote the activities of low-frequency band.95% SEF can effectively monitor the Dex sedation depth.
