CAJ | 학술논문

目的：观察右美托咪定治疗ICU酒精戒断综合征患者的临床疗效及安全性。方法采用随机数字表法将出现震颤（抽搐）、焦虑、激惹等表现的96例ICU酒精戒断综合征患者分为3组，A组给予右美托咪定静脉泵注，负荷量为0．5～1．0μg／kg，10 min后减量至维持量0．2～0．6μg／（kg· h）；B组给予异丙酚静脉泵注，负荷量为0．5～2．0 mg／kg，10 min后减量至维持量1～3 mg／（ kg· h）；C组给予地西泮肌肉注射镇静。观察3组镇静效果；记录用药前后患者的平均动脉压、心率、呼吸频率、脉搏血氧饱和度、动脉血氧分压、CIWA－Ar评分、APACHEⅡ评分，统计患者住ICU时间、不良反应发生情况及病死率。结果 A、B组镇静达标率明显高于C组（P均＜0．05），A组与B组比较差异无统计学意义（P＞0．05）。 B组镇静起效时间最短，地西泮用量最少，3组间比较差异均有统计学意义（P均＜0．05）。 A组用药后1 h的平均动脉压、心率明显低于B、C组（P＜0．05），3组用药前后呼吸频率、脉搏血氧饱和度、动脉血氧分压均无明显变化（P均＞0．05）。3组用药后24 h CIWA－Ar评分及APACHEⅡ评分均较用药前明显下降（P均＜0．05），A组评分明显低于B、C组（P均＜0．05）。 A组住ICU时间明显短于C组（ P＜0．05）。结论右美托咪定可显著缓解酒精戒断综合征患者的躁动、谵妄等症状，改善预后，且不良反应少，可作为酒精戒断综合征患者镇静的临床推荐药物。
목적：관찰우미탁미정치료ICU주정계단종합정환자적림상료효급안전성。방법채용수궤수자표법장출현진전（추휵）、초필、격야등표현적96례ICU주정계단종합정환자분위3조，A조급여우미탁미정정맥빙주，부하량위0．5～1．0μg／kg，10 min후감량지유지량0．2～0．6μg／（kg· h）；B조급여이병분정맥빙주，부하량위0．5～2．0 mg／kg，10 min후감량지유지량1～3 mg／（ kg· h）；C조급여지서반기육주사진정。관찰3조진정효과；기록용약전후환자적평균동맥압、심솔、호흡빈솔、맥박혈양포화도、동맥혈양분압、CIWA－Ar평분、APACHEⅡ평분，통계환자주ICU시간、불량반응발생정황급병사솔。결과 A、B조진정체표솔명현고우C조（P균＜0．05），A조여B조비교차이무통계학의의（P＞0．05）。 B조진정기효시간최단，지서반용량최소，3조간비교차이균유통계학의의（P균＜0．05）。 A조용약후1 h적평균동맥압、심솔명현저우B、C조（P＜0．05），3조용약전후호흡빈솔、맥박혈양포화도、동맥혈양분압균무명현변화（P균＞0．05）。3조용약후24 h CIWA－Ar평분급APACHEⅡ평분균교용약전명현하강（P균＜0．05），A조평분명현저우B、C조（P균＜0．05）。 A조주ICU시간명현단우C조（ P＜0．05）。결론우미탁미정가현저완해주정계단종합정환자적조동、섬망등증상，개선예후，차불량반응소，가작위주정계단종합정환자진정적림상추천약물。
Objective It is to observe the clinical effect and adverse reaction of dexmedetomidine ( DEX) in alcohol with-drawal syndrome patients (AWS) in ICU.Methods 96 AWS patients with nystagmus, anxiety, irritability symptoms were ran-domly divided into group A(n=32), group B(n=32) and group C(n=32) by random number table method.Group A were injected intravenously of dexmedetomidine load 0.5-1.0 μg/kg within 10 minutes and maintained at 0.2-0.6 μg/kg/h, Group B were injected intravenously of propofol load 0.5-2.0 mg/kg within 10 minutes and maintained 1 -3 mg/kg/h, Group C were injected intramuscular of diazepam temporarily .The sedative effect , mean arterial pressure , heart rate , respira-tory rate, pulse oxygen saturation , arterial oxygen partial pressure , CIWA-Ar score, APACHEⅡscore before treatment and after treatment were compared in the three groups .The ICU hospitalized time and mortality were analyzed in the three groups . The incidence of adverse effects include bradycardia , hypotension and respiratory depression were observed .Results The seda-tion good control rates in group A and group B was higher than that in group C (P<0.05), but there was no significant differ-ence between group A and group B (P>0.05).The onset time of sedation was the shortest and dosage of diazepam was the least in group B, the differences were significantly different among the three groups (P all<0.05).Group A's MAP and heart rate at 1 hour after medication was lower than that of Group B and C (P<0.05).The changes of respiratory rate , pulse oxygen saturation and arterial oxygen partial pressure in three groups were not significant (P>0.05).CIWA-Ar score and APACHEⅡscore of three groups were decreased compared with than before treatment (P<0.05), the scores of Group A were signifi-cantly decreased especially .Group A's ICU hospitalization time was shorter than that of Group C (P<0.05).Conclusion Dexmedetomidine can effectively relieve AWS symptoms such as agitation or delirium with less adverse effects .It can be rec-ommended in sedation treatment in AWS patients .