CAJ | 학술논문

目的：探讨右美托咪定和丙泊酚用于心脏术后机械通气患者的镇静效果和安全性。方法选取心脏术后转入ICU行机械通气患者70例，将患者分为右美托咪定组35例和丙泊酚组35例。以Riker镇静和躁动评分3～4分为镇静目标，根据镇静目标对镇静、镇痛药物作剂量调节。观察两组患者镇静评分、机械通气时间、舒芬太尼用量、血管活性药物使用时间及停镇静药至拔管时间。观察两组患者平均动脉血压（ MAP）下降、躁动或谵妄、心动过缓等不良反应发生率。结果两组患者镇静效果均控制在Riker镇静和躁动评分（SAS）3～4分，差异无统计学意义（P＞0.05）；两组患者机械通气时间、血管活性药物使用时间差异无统计学意义（P＞0.05）；右美托咪定组舒芬太尼使用量及停镇静药至拔管时间少于丙泊酚组（P＜0.01）。两组在镇静目标范围内MAP下降及心动过缓发生率差异无统计学意义（P＞0.05）。右美托咪定组躁动或谵妄发生率为14.3％，低于丙泊酚组的40.0％（ P＜0.05）。结论右美托咪定用于心脏术后患者机械通气镇静安全有效，可降低躁动或谵妄发生率。
목적：탐토우미탁미정화병박분용우심장술후궤계통기환자적진정효과화안전성。방법선취심장술후전입ICU행궤계통기환자70례，장환자분위우미탁미정조35례화병박분조35례。이Riker진정화조동평분3～4분위진정목표，근거진정목표대진정、진통약물작제량조절。관찰량조환자진정평분、궤계통기시간、서분태니용량、혈관활성약물사용시간급정진정약지발관시간。관찰량조환자평균동맥혈압（ MAP）하강、조동혹섬망、심동과완등불량반응발생솔。결과량조환자진정효과균공제재Riker진정화조동평분（SAS）3～4분，차이무통계학의의（P＞0.05）；량조환자궤계통기시간、혈관활성약물사용시간차이무통계학의의（P＞0.05）；우미탁미정조서분태니사용량급정진정약지발관시간소우병박분조（P＜0.01）。량조재진정목표범위내MAP하강급심동과완발생솔차이무통계학의의（P＞0.05）。우미탁미정조조동혹섬망발생솔위14.3％，저우병박분조적40.0％（ P＜0.05）。결론우미탁미정용우심장술후환자궤계통기진정안전유효，가강저조동혹섬망발생솔。
Objective To compare the sedative effect and safety of dexmedetomidine and propofol for pa-tients undergoing mechanical ventilation after cardiac surgery.Methods A total of 70 patients undergoing mechanical ventilation after cardiac surgery in the intensive care unit( ICU) were enrolled.They were treated either with propofol (35 cases in propofol group) or dexmedetomidine(35 cases in dexmedetomidine group).The dose of sedation was regulated by Riker sedation-agitation scale( SAS) maintaining 3~4 sedative score.During the course, the amount of the sufentanil, duration of mechanical ventilation, using time of vasoactive agent, SAS score, extubation time,and in-cidence of side-effects such as hypotension, bradycardia, delirium or agitation, etc were recorded in the two groups. Results There was no statistically significant difference in the sedative effect between the two groups.Riker SAS score was maintained in 3~4 sedative scores(P>0.05).When compared with the propofol group, in the dexme-detomidine group, the dose of sufentanil was smaller(P<0.01), extubation time was shorter(P<0.01), the rates of hypotension and bradycardia were the same( P>0.05) ,and the duration of mechanical ventilation, using time of vasoactive agent, SAS score were the same(P>0.05).The rate of delirium or agitation in the dexmedetomidine was lower than that in the propofol group(14.3%vs 40.0%, P<0.05).Conclusion Sedative effect of dexmedetomi-dine is satisfactory and effective for patients undergoing mechanical ventilation after cardiac surgery.It can reduce the rate of delirium or agitation.