摘要
目的探讨右美托咪啶对不同年龄段重症监护室（ICU）机械通气患者的镇静有效性和安全性。方法选择不同年龄段[25～50岁（A组）、51～80岁（B组）]入住ICU的机械通气患者各157例。给予右美托咪啶直至获得目标镇静（Ramsay评分3～4分）。期间连续监测无创血压（SBP、DBP、MAP）、心率（HR）、氧饱和度（Sp O2）、呼吸频率（RR）和吸入氧浓度（Fi O2）变化,于用药前（T1）及用药后10min（T2）、30min（T3）、120min（T4）、拔管时（T5）、拔管后30min（T6）记录上述各参数。观察并记录用药后不良反应（高血压、低血压、心动过速、心动过缓及谵妄等）的发生情况。结果 A、B两组患者使用右美托咪啶后SBP、DBP、MAP、HR均降低（P〈0.05）,以B组下降更为明显,但仍维持于可接受范围（MAP〉80mm Hg,HR〉60次/min）;两组RR均减低（P〈0.05）,但Fi O2未受影响（P〉0.05）;Sp O2始终未降低,使用右美托咪啶30min后甚至较前上升（P〈0.05）。两组拔管前后血压、Sp O2、RR稳定（P〉0.05）,B组患者HR稍减慢（P〈0.05）;B组发生不良反应的概率明显高于A组（P〈0.05）。结论右美托咪啶用于不同年龄组机械通气及拔管患者均无明显呼吸抑制,血流动力学稳定,是理想的镇静药物选择。但对于年老患者使用时需加强监护,尤其早期使用负荷剂量时,应防止低血压及心动过缓等不良反应的发生并及时处理。
Objectives To provide basis for the safe use of indigenous dexmedetomidine hydrochloride by observing its sedative effect and safety when it was given to mechanically ventilated patients of different ages. Methods Three hundred and fourteen mechanically ventilated patients were admitted to our ICU. According to the age, patients were divided into two subgroups： group A（25-50 years old） and group B（51-80 years old）, with 157 patients in each group. Dexmedetomidine was given to achieve the target sedation level（Ramsay score 3）. The changes in noninvasive blood pressure（SBP, DBP, MAP）, heart rate, Sp O2, respiratory rate and Fi O2 were continuously monitored and recorded before treatment（T1）, and 10min（T2）, 30min（T3） and 120min（T4） after drug administration, on the instant moment of extubation（T5）, and 30 min after extubation（T6）. The adverse reactions such as hypertension, hypotension, bradycardia, tachycardia, delirium were also observed and recorded after treatment. Results Patients of both A and B groups showed a lowering of SBP, DBP, MAP and HR after treatment with dexmedetomidine, especially in group B（P〈0.05）, though they were still maintained at an acceptable range（MAP〉80mm Hg, HR〉60 times/min）. Respiratory rate was reduced（P〈0.05）, without affecting Fi O2 and PEEP（P〉0.05）. Sp O2 was not reduced, and it even rose 30 min after administration of dexmedetomidine（P〈0.05）. In addition, sedation was maintained in patients of both C and D groups during extubation, and their blood pressure, Sp O2, respiratory rate were maintained stable before and after extubation（P〉0.05）, and the heart rate was slightly slower in group B（P〈0.05）. The probability of occurrence of adverse reactions, such as hypertension, hypotension, tachycardia, bradycardia and delirium was significantly higher in group B than in group A. Conclusions Dexmedetomidine does not depress respiration, and a stable hemodynamics was maintained after extubation in ICU patients undergoing mechanical ventilation, thus it is an ideal sedative drug. But when it is used in elderly patients, proper monitoring should be maintained, especially when a loading dose is used, in order to prevent adverse reactions such as hypotension and bradycardia, and should be corrected in time.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2015年第9期758-762,共5页
Medical Journal of Chinese People's Liberation Army
关键词
右美托咪啶
呼吸
人工
重症监护病房
深度镇静
dexmedetomidine
respiration, artificial
intensive care units
deep sedation
