摘要
目的探讨地佐辛复合右美托咪定在重症医学科清醒患者纤维支气管镜气管插管术中的镇痛镇静效果及安全性。方法将本科2015年1月至2016年12月180例需行气管插管机械通气的清醒患者采用随机数字表法分为A、B、C三组，各60例。A组静脉泵注咪达唑仑0．1mg／kg；B组静脉泵注地佐辛O．1mg／kg＋咪达唑仑0．05mg／kg；C组静脉泵注地佐辛0．1mg／kg＋右美托咪定1μg／kg。观察并比较插管前（T1）、插管时（T2）、插管后10min（B）患者心率（HR）、呼吸频率（RR）、平均动脉压（MAP）、指端血氧饱和度（SpO：）以及插管过程中患者躁动情况（NAAS评分）、气管插管后10rain患者的镇静效果（Ramsay评分）、转人时疾病严重程度评分（APACHEII评分）。结果3组T3时间点HR均较T1时间点显著下降[A组：（99．0±5．2）次／min比（101．2±7．6）次／min，P〈0．05；B组：（97．3±6．1）次／min比（103．0±9．5）次／min，P〈0．05；C组：（94．4±7．2）次／min比（100．0±8．8）次／rain，P〈0．05]。3组RR在T2时间点均较同组T】时间点显著下降[A组：（27．1±2．6）次／min比（28．5±3．6）次／min，P〈0．05；B组：（26．3±2．8）次／min比（28．1±3．3）次／rain，P〈0．05；C组：（25．1±3．5）次／min比（27．6±3．1）次／min，P〈0．05]。B组T3时间点MAP较同组T1、T2时间点下降f（71．2±8．8）mmHg（1mmHg=O．133kPa）比（74．3±8．0）mmHg，P〈0．05；（71．2±8．8）mmHg比（74．3±8．8）mmHg，P〈0．05]。C组T2时间点MAP较同组T1、B时间点下降[（68．4±8．1）mmHg比（73．2±6．3），P〈0．05；（68．4±8．1）mmHg比（72．8±7．6）mmHg，P〈0．05】。T1时间点，3组HR、RR、NAP差异无统计学意义（均P〉0．05）。T2时间点，C组MAP较A、B两组显著下降[（68．4±8．1）mmHg比（73．6±8．6），P〈0．05；（68．4±8．1）mmHg比（74．3±8．8）mmHg，P〈0．05]。T3时间点，C组HR较A、B两组显著下降『（94．4±7．2）次／rain比（99．0±5．2）次／min，P〈0．05；（94．4±7．2）次／min比（97．3±6．1）次／min，P〈0．05]。插管过程中B、C两组MAAS评分均显著低于A组[（3．2±1．0）比（3．9±1．0），P〈0．05；（3．0±1．0）比（3．9±1．0），P〈0．051，但B、C组间差异无统计学意义（P〉0．05）。气管插管后10min，A组Ramsay评分显著低于B、C两组[（2．4±0．9）比（2．7±0．9），P〈0．05；（2．4±0．9）比（2．8±0．9），P〈0．051，但B、C两组比较差异无统计学意义（P〉0．05）。结论地佐辛复合咪达唑仑或右美托咪定较单纯使用咪达唑仑可显著改善清醒患者气管插管的耐受性并提高镇静效果；地佐辛复合右美托咪定用于清醒患者气管插管镇痛镇静效果确切。
Objective To study the sedation-analgesia effect and safety of the application of dezocine and dexmedetomidine in awake fiberoptic bronchoscopy intubation at intensive care unit. Methods 180 patients needing intubation and mechanical ventilation at the intensive care unit of our hospital from January, 2015 to December, 2016 were randomly divided into group A, group B, and group C, 60 for each group. Group A administered midazolam 0.1 mg/kg before intubation, group B dezocine 0.1 mg/kg and midazolam 0.05 mg/kg, and group C dezocine 0.1 mg/kg and dexmedetomidine 1 lag/kg. The data of heart rate （HR）＇ respiratory rate （RR）, mean arterial pressure （MAP）, and saturation of pulse oxygen （SpO2） were collected and compared before intubation （T1）, during intubation （T2）, and 10 minutes after intubation （T3）. Motor Activity Assessment Scale（MAAS） and Ramsay score were used to evaluate the sedation-agitation effect during intubation and 10 minutes after intubation respectively; and the APACHE II scores were collected to classify the severities of disease. Results In all the three groups, the HR at T3 was significantly lower than that at T1 [group A： （99.0±5.2） beats/min vs. （101.2±7.6） beats/min, P 〈 0.05; group B： （97.3±6.1） beats/min vs. （103.0±9.5） beats/min, P 〈 0.05; group C： （94.4±7.2） beats/min vs. （100.0±8.8） beats/min, P 〈 0.05]. In all the three groups, the RR at T2 was significantly lower than that at T, [group A： （27.1±2.6） times/rain vs. （28.5±3.6） times/min, P 〈 0.05; group B： （26.3±2.8） times/min vs. （28.1±3.3） times/min, P 〈 0.05; （25.1±3.5） times/min vs. （27.6±3.1） times/min, P 〈 0.05]. The MAP at T3 was significantly lower than those at T1 and T2 in group B [（71.2±8.8） mmHg （1 mmHg=0.133 kPa） vs. （74.3±8.0） mmHg, P 〈 0.05; （71.2±8.8） mmHg vs. （74.3±8.8） mmHg, P 〈 0.05]; the MAP at T2 was significantly lower than those at T1 and T3 in group C [（68.4±8.1） mmHg vs. （73.2±6.3） mmHg, P 〈 0.05; （68.4±8.1） mmHg vs. （72.8±7.6） mmHg, P 〈 0.05）]. At T1, there were no statistical differences in HR, RR and MAP among the three groups （all P 〉 0.05）. At T2, the MAP of group C was significantly lower than those of group A and group B [（68.4±8.1） mmHg vs. （73.6±8.6） mmHg, P 〈 0.05; （68.4±8.1） mmHg vs. （74.3±8.8） mmHg, P 〈 0.05）]. At T3, the HR of group C was significantly lower those of group A and group B [（94.4±7.2） beats/min vs. （99.0±5.2） beats/min, P 〈 0.05; （94.4±7.2） beats/min vs. （97.3±6.1） beats/min, P 〈 0.05）]. During intubation, the MAAS scores of group B and group C were lower than that of group A [（3.2±1.0） vs. （3.9±1.0）; P 〈 0.05; （3.0±1.0） vs. （3.9±1.0）, P 〈 0.05）]; however, there was no statistical difference between group B and group C （P 〉 0.05）. After intubation, the Ramsay score was lower in group A than in group B and group C [（2.4±0.9） vs. （2.7±0.9）, P 〈 0.05; （2.4±0.9） vs. （2.8±0.9）, P 〈 0.05）]; however, there was no statistical difference between group B and group C （P 〉 0.05）. Conclusion Better intubation tolerance and sedative effect could be acquired by the administration of dezocine with midazotam or dexmedetomidine than the administration of midazolam alone. The administration of dezocine and dexmedetomidine in awake patients undgoing fiberoptic bronchoscopy intubation could provide a reliable sedation and analgesia effect.
出处
《国际医药卫生导报》
2017年第11期1703-1707,共5页
International Medicine and Health Guidance News
