CAJ | 학술논문

目的：观察右美托咪定对慢性阻塞性肺疾病（COPD）患者撤机后镇痛镇静效果。方法将成功撤机大于12 h 的COPD 患者48例分成2组，对照组给予咪达唑仑复合枸橼酸芬太尼常规镇痛镇静；右美托咪定组给予右美托咪定负荷剂量1．0μg /kg ，静脉推注时间大于10 min ，滴定维持剂量0．2～0．7μg（kg ? h）。保持患者镇静程度（Ramsay）评分3～4分，脑电双频指数（BIS）65～85；面部表情疼痛量表（FPS）0～4分。给药0、1、2、4 h 监测无创动脉血压（NIBP）、心率（HR）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）。结果给药后1、2、4 h 右美托咪定组收缩压（SBP）明显低于对照组（P＜0．05）；3例患者出现SBP ＜90 mm Hg ，对症处理后纠正。给药后0、1、2、4 h 右美托咪定组 HR 无明显改变（P＞0．05）；对照组7例患者因 SpO2低于90％或 PETCO2升高20 mm Hg 退出实验，右美托咪定组镇痛镇静失败率明显低于对照组（P＜0．05）。结论右美托咪定用于COPD 患者撤机后镇痛镇静未产生明显呼吸抑制，安全、有益，能轻度降低血压和心率。
목적：관찰우미탁미정대만성조새성폐질병（COPD）환자철궤후진통진정효과。방법장성공철궤대우12 h 적COPD 환자48례분성2조，대조조급여미체서륜복합구연산분태니상규진통진정；우미탁미정조급여우미탁미정부하제량1．0μg /kg ，정맥추주시간대우10 min ，적정유지제량0．2～0．7μg（kg ? h）。보지환자진정정도（Ramsay）평분3～4분，뇌전쌍빈지수（BIS）65～85；면부표정동통량표（FPS）0～4분。급약0、1、2、4 h 감측무창동맥혈압（NIBP）、심솔（HR）、맥박양포화도（SpO2）、호기말이양화탄분압（PETCO2）。결과급약후1、2、4 h 우미탁미정조수축압（SBP）명현저우대조조（P＜0．05）；3례환자출현SBP ＜90 mm Hg ，대증처리후규정。급약후0、1、2、4 h 우미탁미정조 HR 무명현개변（P＞0．05）；대조조7례환자인 SpO2저우90％혹 PETCO2승고20 mm Hg 퇴출실험，우미탁미정조진통진정실패솔명현저우대조조（P＜0．05）。결론우미탁미정용우COPD 환자철궤후진통진정미산생명현호흡억제，안전、유익，능경도강저혈압화심솔。
Objective To observe the effects of analgesia and sedation with dexemetomidine for chronic obstructive pulmonary disease(COPD) patients withdrawn from mechanic ventilation .Methods 48 cases of COPD patients withdrawn from mechanic ven-tilation successfully were assigned into 2 groups :Control group was given Midazolam and fentanyl for analgesia and sedation ;dex-emetomidine group was given Dexemetomidine with a dose of 1 .0 μg/kg ,the intravenous injection time was more than 10 min and the intravenous titration rate at 0 .2 - 0 .7 μg(kg ? h) ,targeting Ramsay grade :3 - 4 ,bispectral index (BIS) :65 - 85 ,and faces pain scale (FPS) :0 - 4 scores .non-invasive blood pressure(NIBP) ,heart rate(HR) ,saturation of pulse oxygen (SpO2 ) ,pressure of end-tidal carbondioxide(PETCO2 ) were detected continuously at 0 ,1 ,2 ,4 h after administration .Results Compared with control group ,systolic blood pressure(SBP) of dexemetomidine group at 1 ,2 ,4 h after administration significantly decreased (P < 0 .05) , HR did not differ significantly at relative time points (P> 0 .05) .7 cases in control group droped out for SpO 2 < 90% or PETCO2 escalation over 20 mm Hg ,The test failure rate of dexemetomidine group was significantly lower than that of control group (χ2 =6 .02 ,P< 0 .05) .Conclusion Analgesia and sedation with dexemetomidine in intensive care unit (ICU ) for COPD patients with-drawn from mechanic ventilation were safe and beneficial .