CAJ | 학술논문

目的：探讨右美托咪定和脑电双频指数用于重症监护病房（ ICU）机械通气患者的镇静作用。方法手术后需气管插管机械通气的ICU患者58例，随机分为试验组和对照组，各29例。试验组静脉注射右美托咪定0．5μg? kg－1，并以0．2μg? kg－1? h－1的速度静脉泵注。对照组静脉泵注咪达唑仑负荷剂量0．06 mg? kg－1，以0．4 mg? kg－1? h－1的速度维持镇静。记录不同时间2组患者的平均动脉压（MAP），呼吸频率（RR），脉搏血氧饱和度（SpO2），心率（HR）， Ramsay评分，脑电双频指数（ BIS）值，脱机时间，不良反应发生情况。结果镇静前各时间点MAP、呼吸频率、心率和SpO2差异无统计学意义（P＞0．05）；镇静后呼吸频率和心率下降明显，与镇静前比较差异有统计学意义（ P＜0．05）。与镇静前比较，镇静后各时间点 BIS 值显著下降， Ramsay 评分显著升高（ P ＜0．05）。试验组镇静后各时间点BIS值和Ramsay 评分与对照组比较差异无统计学意义（ P＞0．05）。试验组患者谵妄、心动过缓和低血压发生率显著低于对照组（P＜0．05），试验组的入ICU至开始脱机时间显著短于对照组（P＜0．05）。结论右美托咪定在ICU机械通气患者术后的镇静具有良好的效果，不良反应和术后并发症更少。
목적：탐토우미탁미정화뇌전쌍빈지수용우중증감호병방（ ICU）궤계통기환자적진정작용。방법수술후수기관삽관궤계통기적ICU환자58례，수궤분위시험조화대조조，각29례。시험조정맥주사우미탁미정0．5μg? kg－1，병이0．2μg? kg－1? h－1적속도정맥빙주。대조조정맥빙주미체서륜부하제량0．06 mg? kg－1，이0．4 mg? kg－1? h－1적속도유지진정。기록불동시간2조환자적평균동맥압（MAP），호흡빈솔（RR），맥박혈양포화도（SpO2），심솔（HR）， Ramsay평분，뇌전쌍빈지수（ BIS）치，탈궤시간，불량반응발생정황。결과진정전각시간점MAP、호흡빈솔、심솔화SpO2차이무통계학의의（P＞0．05）；진정후호흡빈솔화심솔하강명현，여진정전비교차이유통계학의의（ P＜0．05）。여진정전비교，진정후각시간점 BIS 치현저하강， Ramsay 평분현저승고（ P ＜0．05）。시험조진정후각시간점BIS치화Ramsay 평분여대조조비교차이무통계학의의（ P＞0．05）。시험조환자섬망、심동과완화저혈압발생솔현저저우대조조（P＜0．05），시험조적입ICU지개시탈궤시간현저단우대조조（P＜0．05）。결론우미탁미정재ICU궤계통기환자술후적진정구유량호적효과，불량반응화술후병발증경소。
Objective To explore the sedation effect of dexmedetomi-dine and bispectral index for the treatment of intensive care unit( ICU) patients with mechanical ventilation.Methods A total of 58 postopera-tion ICU patients needing mechanical ventilation were randomized into treatment group and control group. Treatment group was intravenous injected dexmedetomidine 0.5 μg? kg-1 , and 0.2 μg? kg -1? h-1 in-travenous infusion.Control group was intravenous infusion loading dose of midazolam 0.06 mg? kg -1 , intravenous infusion 0.4 mg? kg-1? h-1 to maintain sedation.The arterial pressure ( MAP) , respiratory rate ( RR) , pulmonary cardiac blood oxygen saturation ( SpO2 ) , heart rate ( HR ) , Ramsay score, bispectral index ( BIS) , adverse reactions and complica-tions at different times were monitored.Results MAP, RR, HR and SpO2 at each time were no difference after sedation ( P>0.05).RR and HR decreased obviously compared with before sedation ( P<0.05). Compared with before sedation, BIS value significantly decreased, Ram-say score was significantly higher ( P<0.05 ) .After sedation, the BIS value and Ramsay score had no difference between the two groups (P>0.05).Delirium,beckoning too moderate and hypotension incidence in treatment group were lower those of con-trol group ( P<0.05 ) , duration from ICU arrival to off time and diastasis were significantly shorter than that of control group( P <0.05 ) .Conclusion Dexmedetomidine has good sedation effect for patients with mechanical ventilation with reduced adverse reactions and complications.