盐酸右美托咪定在机械通气撤离期的临床应用研究

摘要

目的 探讨盐酸右荚托咪定时机械通气撤离期患者的镇静效果及安全性.方法 对80例ICU机械通气患者随机分成两组,在撤离机械通气前4h起1组应用盐酸右荚托咪定镇静治疗,直至拔除气管插管后停用盐酸右荚托咪定;2组应用咪迭唑仑镇静治疗,拔管前1h停用咪达唑仑.采用Ramsay评分评价镇静效果,观察所有所有患者在用药前、用药后1Omin、1h、3h、拔管时、拔管后10 min等不同时点心率(HR)、平均动脉压(MAP)、呼吸(R)、血氧饱和度(SaO2)等指标的变化.结果 1组44例患者均能达到稳定的镇静效果,Ramsay评分在3～4分之间,无呼吸抑制发生,均能按时拔管.在拔管前后MAP、HR和SaO2无明显波动.2组36例患者在给药后均能达到稳定的镇静效果,Ramsay评分在3～5分之间,血压及心率稍有下降,但在拔管前1h停药后,34例患者Ramsay评分下降为1～2分.所有患者拔管时MAP及HR明显升高.2例患者因苏醒不佳出现拔管延迟.结论 右荚托咪定可以使机械通气患者保持良好的镇静效果,有效和安全的抑制拔管反应,保持拔管前后的呼吸和血液动力学稳定.%To investigate sedative effect and security of dexmedetomidine on patients in the period just before mechanical ventilation withdrawed. Methods 80 cases with mechanical ventilation in ICU were divided into 2 groups randomly. In the peroid of 4 hours just before mechanical ventilation was withdrawed all the patients in group 1 were sedated with dexmedetomidine till endotracheal intubation was withdrawed and all the patients in group 2 were sedated with midazolam. Sedation level was asssessed using the ramsay scale, and heart rate(HR) , mean arterial pressure (MAP) -.breath frequency(R) and pulse oxygen saturation (SaO2) were recorded at different time points : before the drug using, l0min, lh, 3h after using, while extubation, and lOmin after withdrawed. Results Stable sedative effect was gained in all 44 patients in group 1, and Ramsay scores were showed between 3 ~4. No respiratory depression was found and endotracheal intubation was withdrawed on time. No significant change was found in breath frequency and pulse oxygen saturation between before and after endotracheal intubation withdrawal. Stable sedative effect was gained in all 36 patients in group 2, and Ramsay scores were showed between 3 ~ 5. Blood pressure and heart rate showed a little decreasing after using Midazolam. When Midazolam was stoped using before 1 hour of extubation,Ramsay scores were decreased to 1 ~ 2 in 34 patients. Blood pressure and heart rate showed significantly increasing when endotrache-al intubation was withdrawed in all patients. Extubation was delayed because of not fully awake in 2 patients. Conclusion An effec-tive sedation level can be achieved, by using Dexmedetomidine in mechanically ventilated patients and extubation reaction was depressed effectively and safely. Respiraton and hemodynamic could be stablely maitained before and after extubation by using Dexme-detomidine.