摘要
目的探讨右美托咪定用于重症监护病房(ICU)正颌外科术后留置气管插管患者镇静作用的有效性和安全性。方法 40例正颌外科术后入ICU留置气管插管患者,随机分为右美托咪定组和咪达唑仑组,每组20例。右美托咪定组予右美托咪定0.4μg·kg^(-1)·h^(-1)微泵静注,调整范围0.2～0.7μg·kg^(-1)·h^(-1);咪达唑仑组予咪达唑仑0.1 mg·kg^(-1)·h^(-1)微泵静注,调整范围0.05～0.2 mg·kg^(-1)·h^(-1)。采用Ramsay镇静深度评分系统,以Ramsay评分2～4分级为镇静目标,进行注射剂量的调整。记录用药前,用药后1、2、3、4、6、8、12、16 h的血压、心率、呼吸、脉搏血氧饱和度,观察镇静效果及不良反应。结果 2组患者用药后均可获得满意的镇静效果,Ramsay评分维持在2～4分级,良好耐受气管插管。2组用药前心率、平均动脉压(MAP)无显著差异(P>0.05),用药后心率和血压均有所下降,右美托咪定组各时点心率均低于咪达唑仑组(P<0.05),用药后1、2、3、4 h MAP低于咪达唑仑组(P<0.05)。2组呼吸频率、脉搏血氧饱和度无显著差异(P>0.05)。右美托咪定组需剂量调整的次数(2例1次)较咪达唑仑组(3例1次,4例2次)低。右美托咪定组发生2例心动过缓,予以阿托品治疗好转,2组均无严重不良反应发生。结论右美托咪定0.4μg·kg^(-1)·h^(-1)可安全用于ICU正颌外科术后留置气管插管患者的镇静,剂量调整发生率低于咪达唑仑。
AIM To study the effectiveness and safety of dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery admitted to intensive care unit （ICU）. METHODS Forty post-operative patients undergoing orthognathic surgery with tracheal intubation in ICU were enrolled and randomized into 2 groups to receive either midazolam or dexmedetomidine. The dexmedetomidine group starting dose was 0.4 μg·kg^-1·h^-1 without a loading dose and adjusted 0.2 to 0.7 μg·kg^-1·h^-1. The midazolam group starting dose was 0.1 mg·kg^-1·h^-1 and adjusted 0.05 to 0.2 mg·kg^-1·h^-1, the dose of sedation was regulated by Ramsay Sedation Score （RSS） maintain 2 to 4 sedative score. During the course, RSS, heart rate （HR）, blood pressure, respiratory rate （RR） and pulse oxygen saturation （SpO2） were observed and registered continuously. The amount of the drug, and incidence of adverse reactions, such as hypotension, bradycardia, delirium, etc. were recorded in two groups. RESULTS The expected sedative scores were obtained in all patients in two groups. The HR and mean arterial blood pressures （MAP） showed no significantly different between two groups before sedation （P 〉 0.05）. The HR in the dexmedetomidine group at 1, 2, 3, 4, 6, 8, 12 and 16 h were lower compared with those in the midazolam group （P 〈 0.05）. The MAP in the dexmedetomidine group at 1, 2, 3, and 4 h were lower than those in the midazolam group （P 〈 0.05）.The times of dose adjustment needed were significantly lower in the dexmedetomidine group （2 patients with 1 adjustment each） than those in the midazolam group （3 patients with 1 adjustment, 4 patients with 2 adjustments）. Atropine was administered to 2 patients in the dexmedetomidine group because of bradycardia. No serious adverse reactions occun＇ed in both groups. CONCLUSION Dexmedetomidine 0.4 μg·kg^-1·h^-1 is effective sedatives for post-operative patients undergoing orthognathic surgery with tracheal intubation i
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2012年第8期454-457,共4页
Chinese Journal of New Drugs and Clinical Remedies
