CAJ | 학술논문

目的：探讨右美托咪定用于ICU机械通气患者镇痛镇静的临床疗效。方法选择2011－01～2014－05间在我科使用右美托咪定和咪达唑仑复合酒石酸布托啡诺镇静镇痛治疗机械通气的40例患者，右美托咪定组20例，给予右美托咪定复合酒石酸布托啡诺镇静镇痛治疗；咪达唑仑组20例，给予咪达唑仑复合酒石酸布托啡诺镇静镇痛治疗；维持Ramsay镇静评分3～4分，记录两组患者布托啡诺用量、达到目标镇静所需的时间、停药后唤醒时间、谵妄发生率，以及两组患者用药前（T0），用药后1 h（T1），用药后6 h（T6），用药后12 h（T12）的血氧饱和度、心率、收缩压、舒张压、呼吸频率等数值。结果右美托咪定组布托啡诺用量、达到目标镇静所需的时间、停药后唤醒时间、谵妄发生率均低于咪达唑仑组，差异有统计学意义（ P＜0.05）；与T0比较，两组不同时间点心率、收缩压、舒张压、呼吸频率均降低，差异有统计学意义（P＜0.05），两组血氧饱和度变化不大（P＞0.05）；用药后各时间点两组间比较，右美托咪定组心率、收缩压，舒张压降低幅度小于咪达唑仑组（P＜0.05），两组间血氧饱和度和呼吸频率无显著差异（ P＞0.05）。结论右美托咪定用于ICU机械通气患者镇静起效快，易唤醒，具有一定镇痛作用，可减少布托啡诺用量，镇静过程中血流动力学稳定，呼吸抑制作用轻微，谵妄等不良反应发生率低。
목적：탐토우미탁미정용우ICU궤계통기환자진통진정적림상료효。방법선택2011－01～2014－05간재아과사용우미탁미정화미체서륜복합주석산포탁배낙진정진통치료궤계통기적40례환자，우미탁미정조20례，급여우미탁미정복합주석산포탁배낙진정진통치료；미체서륜조20례，급여미체서륜복합주석산포탁배낙진정진통치료；유지Ramsay진정평분3～4분，기록량조환자포탁배낙용량、체도목표진정소수적시간、정약후환성시간、섬망발생솔，이급량조환자용약전（T0），용약후1 h（T1），용약후6 h（T6），용약후12 h（T12）적혈양포화도、심솔、수축압、서장압、호흡빈솔등수치。결과우미탁미정조포탁배낙용량、체도목표진정소수적시간、정약후환성시간、섬망발생솔균저우미체서륜조，차이유통계학의의（ P＜0.05）；여T0비교，량조불동시간점심솔、수축압、서장압、호흡빈솔균강저，차이유통계학의의（P＜0.05），량조혈양포화도변화불대（P＞0.05）；용약후각시간점량조간비교，우미탁미정조심솔、수축압，서장압강저폭도소우미체서륜조（P＜0.05），량조간혈양포화도화호흡빈솔무현저차이（ P＞0.05）。결론우미탁미정용우ICU궤계통기환자진정기효쾌，역환성，구유일정진통작용，가감소포탁배낙용량，진정과정중혈류동역학은정，호흡억제작용경미，섬망등불량반응발생솔저。
Objective To analyze clinical effects of dexmedetomidine combined with Butorphanol tartrate on sedation of mechanically ventilated ICU patients.Methods 40 patients from January , 2010 to December , 2013 using dexmedetomidine and midazolam combined with Butorphanol tartrate for sedation and analgesia were reviewed.All the patients were divided into two groups: dexmedetomidine group and midazolam group.There were 20 patients in the dexmedetomidine group , using dexmedetomidine combined with Butorphanol tartrate for sedation and analgesia.And there were 20 patients in midazolam group.The Ramsay score maintained 3~4, dosage of Butorphanol , the time required to achieve the desired sedation , recovery time after treatment ,incidence of delirium were recorded.The HR, SBP, DBP, RR and SPO2 at pre-administration (T0), 1 hour after administration(T1), 6 hour after administration (T6) and 12 hour after administration (T12) were recorded.Results The dosage of Butorphanol , the time required to achieve the desired sedation , recovery time after treat-ment, incidence of delirium of dexmedetomidine group were lower than those of midazolam group ;compared with T0, two groups had a de-crease in HR, SBP, DBP, RR and had no change in SPO 2 after administration.HR, SBP and DBP of dexmedetomidine group decreased less than those of midazolam group and there were no difference in RR and SPO 2 of two groups in different times after administra-tion.Conclusion There are some characters including rapid onset , easy to wake up and low incidence of delirium.The amount of Butor-phanol can be reduced with stable hemodynamics , small influence on breathing and circulatory system , and low occurence rate of delirium.