右旋美托咪啶用于重症监护病房患者镇静的脑电研究  

Electroencephalography study of patients sedated with dexmedetomidine in intensive care unit

作　　者：殷文渊[1] 邓羽霄[1] 杜唯佳[1] 李雯[1] 王祥瑞[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,200127

出　　处：《上海医学》2009年第11期944-948,共5页Shanghai Medical Journal

摘　　要：目的研究右旋美托咪啶(Dex)的镇静效应和脑电变化。方法选择手术后需气管插管机械通气镇静时间大于6 h的重症监护病房(ICU)患者30例,随机双盲分为Dex组(D组,输注Dex)和空白对照组(C组,输注0.9%氯化钠溶液)。分两个阶段给药,先以6.0μg.kg-1.h-1经静脉泵注射给药10 min,随后以0.4μg.kg-1.h-1的速度维持给药,记录给药前(T0)及持续输注后5 min(T1)、10 min(T2)、20 min(T3)、30 min(T4)的Ramsay镇静评分和脑电数据。结果D组T1～T4时间点的Ramsay镇静评分均显著低于C组(P值均<0.01)。能量光谱分析显示,D组T1～T4时间点的β波能量显著低于C组、δ波能量显著高于C组(P值分别<0.05、0.01),T2～T4时间点的θ波能量显著高于C组(P值均<0.05),两组间各时间点α波能量的差异均无统计学意义(P值均>0.05)。D组T2～T4时间点的相对β波能量和相对α波能量显著低于C组(P值分别<0.01、0.05)、相对δ波能量显著高于C组(P值均<0.01),两组间各时间点相对θ波能量的差异均无统计学意义(P值均>0.05)。D组T1～T4时间点的95%频谱边界频率(SEF)均显著低于C组(P值分别<0.01、0.05)。相关分析结果显示,Ramsay镇静评分与95%SEF呈负相关(r=-0.694,P<0.01)。结论Dex可以产生明显的镇静作用,会抑制人类脑电的高频率波段活动,增加低频率波段活动,95%SEF可以有效地监测Dex的镇静深度。Objective To investigate the sedation effects of dexmedetomidine （Dex） and its influence on the electroencephalographic activity of patients. Methods Thirty patients （American Society of Anesthesiologists Ⅰ-Ⅱ ） who needed ventilation for over 6 hours after operation in the intensive care unit （ICU） were randomly divided into Dex group （group D, infusion of Dex, n = 15） and control group （group C, infusion of normal saline, n=15）. The drugs were given by two stages： first injection at 6.0 μg·kg-1·h-1 for 10 min, and then maintained at 0.4μg·kg-1·h-1 We recorded the Ramsay sedation score and electroencephalography （EEG） data before administration （T0） and 5 min （T1）, 10 min （T2）, 20 min （T3）, 30 min （.T4 ） after continuous infusion. Results The Ramsay sedation scores of group D at T--T4 were significantly decreased compared with those of Group O （P〈0.01）. Spectrum analysis showed that the powers of beta in group D from T2-T4 was decreased, while the powers of delte at T1- T4 and theta at T2--T4 was increased compared with that in group C （P〈0.05 or 0.01 ）. There was no significant difference in the powers of alpha between two groups. The relative powers of beta and alpha of group D at T2 -T4 was significantly lower than those of group C （P〈O. 01 or 0.05）, the relative delta powers was significantly higher than that of group C （P〈0.01）. There were no significant differences in the relative theta powers between the two groups at all time points （P〉0.05）. The 95% spectral edge frequencies （SEF） of group D at T1- T4 was significantly lower than those of group C after Dex infusion （P〈O. 05 or 0.01 ）. Correlation analysis showed a negative correlation between the Ramsay score and 95% SFF on （r = -0.694,P〈0.01）. Conclusion Dex has obvious sedative effect; it can inhibit the high-frequency band of human brain electric activity and promote the activities of low-frequency band. 95% SEF can effectively monitor the Dex seda

关 键 词：右旋美托咪啶 镇静 脑电图 

分 类 号：R459.7[医药卫生—急诊医学]