右美托咪定在重症急性胰腺炎机械通气患者镇静中的应用

摘要

目的 观察右美托咪定在重症急性胰腺炎机械通气患者镇静中的应用.方法 选择2013年12月至2014年12月入住成都市第五人民医院重症监护病房进行有创机械通气的重症急性胰腺炎患者80例,采用随机数字表法分为观察组和对照组,各40例.观察组给予右美托咪定注射液负荷量0.8 ～ 1.0 μg/kg,后以0.2～0.7 μg/(kg·h)持续静脉微泵泵入;对照组给予咪达唑仑注射液负荷量0.06 mg/kg,后以0.04～0.20 mg/(kg·h)维持;2组均根据镇静效果调整剂量.比较2组Ramsay镇静评分和给药后0、4、8、12h的平均动脉压、心率、呼吸频率,同时观察心动过缓和谵妄发生率.结果 Ramsay 镇静评分3～4级比例观察组与对照组比较[90.0％ (36/40)比85.0％ (34/40)],差异无统计学意义(x2=0.457,P＞0.05).观察组给药后4、8h,对照组给药后12 h的平均动脉压均明显低于给药后0 h[(83 ±5)、(84 ±4)mmHg(1 mmHg =0.133 kPa)比(88 ±9) mmHg,(77 ±6) mmHg比(85 ±7) mmHg],差异均有统计学意义(均P ＜0.05).观察组给药后4、8h和对照组给药后8h心率明显低于给药后0 h[(85 ±23)、(90±24)次/min比(118±24)次/min,(100±19)次/min比(125±17)次/min],观察组给药后4、8h的心率均明显低于对照组,差异有统计学意义(P＜0.05).对照组给药后4、8、12 h的呼吸频率均低于给药后0h[(18±4)、(16±4)、(14±3)次/min比(23±5)次/min],观察组给药后12 h呼吸频率明显高于对照组[(18±5)次/min比(14±3)次/min],差异有统计学意义(P＜0.05).观察组谵妄发生率明显低于对照组[7.5％ (3/40)比25.0％ (10/40)],差异有统计学意义(x2=4.501,P＜0.05).2组心动过缓发生率比较,差异无统计学意义(P＞0.05).结论 右美托咪定用于重症急性胰腺炎机械通气患者镇静效果满意,唤醒时间较短,对呼吸、循环的影响较小,且谵妄发生率低.%Objective To observe the sedative effects of dexmedetomidine in patients with severe acute pancreatitits undergoing mechanical ventilation.Methods Eighty severe acute pancreatiitis patients undergoing mechanical ventilation in intensive care unit from December 2013 to December 2014 were randomly divided into observation group (40 cases) and control group (40 cases).Observation group was intravenously given of dexmedetomidine [loading dose of 0.8-1.0 μg/kg followed by maintained dose of 0.2-0.7 μg/(kg · h)];control group was intravenously given midazolam [loading dose of 0.06 mg/kg followed by maintained dose of 0.04-0.20 mg/(kg · h)];the sedation dose was adjusted according to the effect.The Ramsay sedation score was assessed;the mean arterial pressure, heart rate and respiratory rate 0, 4, 8, 12 h after administration were compared between groups;the incidences of bradycardia and delirium were compared between groups.Results The proportion of patients with Ramsay sedation score 3-4 scores were not significantly different between observation group and control group [90.0％ (36/40) vs 85.0％ (34/40)] (x2 =0.457, P ＞ 0.05).Compared with 0 h after administration, the mean arterial pressure 4 and 8 h after administration in observation group and 12 h in control group after administration was significantly reduced [(83 ± 5), (84 ± 4) mmHg vs (88 ± 9) mmHg, (77 ± 6) mmHg vs (85 ± 7) mmHg].Compared with 0 h after administration, the heart rate 4 and 8 h after administration in observation group and 8 h after administration in control group was significantly reduced [(85 ± 23), (90 ±24) times/min vs (118 ±24) times/min, (100 ± 19) times/min vs (125 ± 17) times/min] (P ＜ 0.05);4 and 8 h after administration, the heart rate in observation group was significantly lower than that in control group (P ＜ 0.05).Compared with 0 h after administration, the respiratory rate 4, 8, 12 h after administration in control group was significantly reduced [(18 ± 4) , (16 ± 4), (14 ± 3) times/min vs (23 ± 5) times/min], and the respiratory rate in observation group 12 h after administration was significantly higher than that in control group [(18 ± 5) times/min vs (14 ± 3) times/min] (P ＜ 0.05).The incidence of delirium in observation group was significantly lower than that in control group [7.5％ (3/40) vs 25.0％ (10/40)] (x2 =4.501, P ＜ 0.05);the incidence of bradycardia was not significantly different between groups (P ＞ 0.05).Conclusion Dexmedetomidine has satisfactory sedation effect in severe acute pancreatitits patients undergoing mechanical ventilation, with short time for wake up, mild influence on respiration and circulation, and low incidence of delirium.