国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2014年
6期
401-404
,共4页
右美托咪啶%术后镇静%镇痛%冠状动脉旁路移植术,非体外循环
右美託咪啶%術後鎮靜%鎮痛%冠狀動脈徬路移植術,非體外循環
우미탁미정%술후진정%진통%관상동맥방로이식술,비체외순배
Dexmedetomidine%Postoperative sedation%Analgesia%Coronary artery bypass,off-pump
目的 评价右美托咪啶对冠状动脉旁路移植术后患者的镇静效果.方法 选取2013年3-9月河南省人民医院心外科择期行冠状动脉旁路移植术患者96例,其中男性58例,女性38例,年龄36～ 68岁,平均(56±18)岁,ASA分级为Ⅱ或Ⅲ级,采用随机数字表法,随机分为两组:右美托咪啶组(A组,n=48)和咪达唑仑组(B组,n=48).其中A组,右美托咪啶负荷量1 μg/kg在10 min静脉输注,之后以0.2～0.7 μg· kg-1·h-1持续静脉泵入;B组,以咪达唑仑0.05 mg/kg在10 min静脉输注,之后以0.02 ～0.10 mg·kg-1·h-1静脉泵入,维持Riker镇静和躁动评分在3～4分,两组患者在达到脱机和气管拔管标准时停药.观察达到目标镇静范围的起效时间和用药前后、苏醒时的心率、呼吸、血压、血氧饱和度的变化,苏醒时间,术后机械通气时间,拔管时间及ICU留住时间,不良事件病例数.结果 在目标镇静范围内两组之间差异无统计学意义(右美托咪啶组为75.5％,咪达唑仑组为74.6％,P＞0.05),右美托咪啶组较咪达唑仑组停药苏醒快[右美托咪啶组为(14.0 ±6.2)min,咪达唑仑组为(50.4±12.8)min,P＜0.05)],谵妄发病率低(右美托咪啶组为15.3％,咪达唑仑组为34.6％,P＜0.05)、机械通气时间短(P＜0.05).两组ICU留住时间相似,右美托咪啶组患者相对咪达唑仑组患者更容易出现心动过缓,但需要治疗的比例无明显增加,咪达唑仑组更容易出现心动过速和高血压.结论 右美托咪啶用于心外科冠状动脉旁路移植术患者的术后镇静是安全有效的.
目的 評價右美託咪啶對冠狀動脈徬路移植術後患者的鎮靜效果.方法 選取2013年3-9月河南省人民醫院心外科擇期行冠狀動脈徬路移植術患者96例,其中男性58例,女性38例,年齡36～ 68歲,平均(56±18)歲,ASA分級為Ⅱ或Ⅲ級,採用隨機數字錶法,隨機分為兩組:右美託咪啶組(A組,n=48)和咪達唑崙組(B組,n=48).其中A組,右美託咪啶負荷量1 μg/kg在10 min靜脈輸註,之後以0.2～0.7 μg· kg-1·h-1持續靜脈泵入;B組,以咪達唑崙0.05 mg/kg在10 min靜脈輸註,之後以0.02 ～0.10 mg·kg-1·h-1靜脈泵入,維持Riker鎮靜和躁動評分在3～4分,兩組患者在達到脫機和氣管拔管標準時停藥.觀察達到目標鎮靜範圍的起效時間和用藥前後、囌醒時的心率、呼吸、血壓、血氧飽和度的變化,囌醒時間,術後機械通氣時間,拔管時間及ICU留住時間,不良事件病例數.結果 在目標鎮靜範圍內兩組之間差異無統計學意義(右美託咪啶組為75.5％,咪達唑崙組為74.6％,P＞0.05),右美託咪啶組較咪達唑崙組停藥囌醒快[右美託咪啶組為(14.0 ±6.2)min,咪達唑崙組為(50.4±12.8)min,P＜0.05)],譫妄髮病率低(右美託咪啶組為15.3％,咪達唑崙組為34.6％,P＜0.05)、機械通氣時間短(P＜0.05).兩組ICU留住時間相似,右美託咪啶組患者相對咪達唑崙組患者更容易齣現心動過緩,但需要治療的比例無明顯增加,咪達唑崙組更容易齣現心動過速和高血壓.結論 右美託咪啶用于心外科冠狀動脈徬路移植術患者的術後鎮靜是安全有效的.
목적 평개우미탁미정대관상동맥방로이식술후환자적진정효과.방법 선취2013년3-9월하남성인민의원심외과택기행관상동맥방로이식술환자96례,기중남성58례,녀성38례,년령36～ 68세,평균(56±18)세,ASA분급위Ⅱ혹Ⅲ급,채용수궤수자표법,수궤분위량조:우미탁미정조(A조,n=48)화미체서륜조(B조,n=48).기중A조,우미탁미정부하량1 μg/kg재10 min정맥수주,지후이0.2～0.7 μg· kg-1·h-1지속정맥빙입;B조,이미체서륜0.05 mg/kg재10 min정맥수주,지후이0.02 ～0.10 mg·kg-1·h-1정맥빙입,유지Riker진정화조동평분재3～4분,량조환자재체도탈궤화기관발관표준시정약.관찰체도목표진정범위적기효시간화용약전후、소성시적심솔、호흡、혈압、혈양포화도적변화,소성시간,술후궤계통기시간,발관시간급ICU류주시간,불량사건병례수.결과 재목표진정범위내량조지간차이무통계학의의(우미탁미정조위75.5％,미체서륜조위74.6％,P＞0.05),우미탁미정조교미체서륜조정약소성쾌[우미탁미정조위(14.0 ±6.2)min,미체서륜조위(50.4±12.8)min,P＜0.05)],섬망발병솔저(우미탁미정조위15.3％,미체서륜조위34.6％,P＜0.05)、궤계통기시간단(P＜0.05).량조ICU류주시간상사,우미탁미정조환자상대미체서륜조환자경용역출현심동과완,단수요치료적비례무명현증가,미체서륜조경용역출현심동과속화고혈압.결론 우미탁미정용우심외과관상동맥방로이식술환자적술후진정시안전유효적.
Objective To evaluate the effectiveness and safety of dexmedetomidine for the sedation of the patients after coronary artery bypass grafting (CABG).Methods The selective 96 CABG patients,ASA Ⅱor Ⅲ,aged 36 to 68 years old,58 males and 38 females,were randomly divided into 2 groups (n =48):dexmedetomidine group (group A) and midazolam group (group B).Group A patients received Dexmedetomidine (1.0 μg/kg)over 10 min,followed by 0.2-0.7 μg · kg-1 · h-1 to maintain sedation,whereas the other group patients received midazolam (0.05 mg/kg) over 10 min,followed by 0.02-0.10 mg · kg-1 · h-1 to maintain sedation.Two groups of patients stopped using drug when they were fit off-line and extubation.Observe the percentage of time within target sedative scope (Riker range 3-4),the changes of vital signs before and after treatment,the prevalence of delirium,the awakening time,the duration of mechanical ventilation,ICU length of stay,the adverse events of blood pressure and heart rate.Results There were no significant difference in the percentage of time within target sedative scope between two groups (75.5％ for dexmedetomidine group vs 74.6％ for midazolam group,P ＞ 0.05).Compared to midazolam group,the Dexmedetomidine group has a shorter awakening time [(14.0 ± 6.2) min for dexmedetomidine group vs (50.4 ± 12.8) min for midazolam group,P ＜ 0.05] and duration of mechanical ventilation,and also the prevalence of delirium was lower(15.3％ for dexmedetomidine group vs 34.6％ for midazolam group,P ＜0.05).ICU length of stay was similar.Dexmedetomidine-treated patients were more likely to develop bradcardia,with a non significant increase in the proportion requiring treatment,but had a lower likelihood of tachycardia or hypertension requiring treatment.Conclusion Dexmedetomidine is safe and effective in patients after CABG surgery.
