摘要
目的 评估右美托咪定用于老年患者外科术后机械通气中的镇静效果及安全性.方法 采用前瞻性随机对照研究,将纳入研究的外科术后需行机械通气的老年患者108例随机分为两组（n=54）,分别给予右美托咪定和丙泊酚镇静治疗,根据Ramsay镇静评分调整镇静药物剂量,使镇静深度评分控制在3～4级,两组均常规给予芬太尼持续静脉泵入镇痛,根据NRS镇痛评分调整芬太尼剂量,使疼痛评分维持在0～3分;应用丙泊酚作为补救药物.观察记录两组的Ramsay镇静评分（NRS）,静脉推注丙泊酚的次数,最高NRS评分,芬太尼用药总量,停药后苏醒时间以及机械通气时间和ICU住院时间,同时比较谵妄和心血管不良事件发生率.结果 两组镇静效果比较无显著差异,但与丙泊酚组相比,右美托咪定组NRS评分较低[（1.8±1.12分）比（3.1±1.24）分,P＜0.05）];芬太尼用药总量较少[（427.6±14.1）μg比（658.4±27.3）μg,P＜0.05],停药后苏醒时间较短[（0.3±0.02）h比（1.1 ±0.3）h,P＜0.05].右美托咪定组中位机械通气时间为（21.0 h,95％CI：18.6～21.4 h）,短于丙泊酚组（28.0 h,95％CI：25.6 ～30.4 h）,两组比较差异有统计学意义（P＜0.05）;而两组ICU住院时间,谵妄发生率比较差异无统计学意义.右美托咪定组出现心率降低2例,丙泊酚组出现血压下降2例.结论 右美托咪定用于老年患者外科术后机械通气的镇静是安全有效的,且具有较好的镇痛作用,停药后苏醒更快,机械通气时间更短,但并不能降低此类患者谵妄发生率和ICU住院时间.
Objective To evaluate the efficacy and safety of dexmedetomidine for post-operative elder patients on mechanical ventilation （MV）.Methods For this randomized controlled trial,108 cases of post-operative patients on MV were enrolled and assigned into either dexmedetomidine group （n =54） or propofol group （n =54） for sedation.And propofol was used for rescue.The dose of sedation was regulated by Ramsay score for maintaining a sedative score of 3-4.In both groups,fentanyl was provided intravenously continually for analgesia.The amount of fentanyl was adjusted according to the numerical rating scale （NRS） score for maintaining an analgesic score of 0-3.The average Ramsay score,the frequency of propofol,the highest score of NRS,the total dosage of fentanyl and recovery time were compared.Additional outcomes included duration of mechanical ventilation and intensive care unit （ICU） length.And the incidence of delirium and cardiovascular adverse events were compared for two groups.Results No significant inter-group difference existed in the effectiveness of sedation.Compare with propofol group,the highest score of NRS decreased （1.8 ± 1.12 vs 3.1 ± 1.24,P 〈 0.05）,the total dosage of fentanyl significantly decreased （427.6 ± 14.1 vs 658.4 ± 27.3 μg,P 〈 0.05） and recovery time became significantly shortened （0.3 ± 0.02 h vs 1.1 ± 0.3 h,P 〈 0.05） in dexmedetomidine group.Median duration of mechanical ventilation in dexmedetomidine group （21.0 h,95% CI：18.6-21.4 h） was significantly shorter than that in propofol group（28.0 h,95% CI：25.6-30.4 h） （P 〈0.05）.No intergroup differences existed in the ICU length of stay and the incidence of delirium.Two cases in dexmedetomidine group developed bradycardia while hypotension occurred in two cases of propofol group.Conclusion Sedative effects of dexmedetomidine are safe and effective for post-operative elder patients on MV.And it offers a better efficacy of analgesia and shorter durations of MV and recovery time.But dexmedetomidine had no significant influence on the ICU length of stay or the incidence of delirium.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第41期3211-3215,共5页
National Medical Journal of China
关键词
通气机
机械
清醒镇静
镇痛
老年人
右美托咪定
Ventilators,mechanical
Conscious sedation
Analgesia
Aged
Dexmedetomidine
