右美托咪定在术后机械通气患者中的应用  

Use of dexmedetomidine in the postoperative patients with mechanical ventilation

作　　者：李华卿[1] 侯大鹏[1] 姜翠华[1] 韩承河[1] 

机构地区：[1]泰山医学院附属医院ICU,山东泰安271000

出　　处：《中国急救医学》2011年第8期697-700,共4页Chinese Journal of Critical Care Medicine

基　　金：泰山医学院自然科学青年基金（No.2010QNZR018）

摘　　要：目的 对右美托咪定用于术后机械通气患者短时镇静镇痛的安全性及有效性进行评估.方法 采用随机对照研究,将纳入病例随机分为两组,分别应用右美托咪定、咪达唑仑进行镇静镇痛治疗,应用咪达唑仑和吗啡作为补救药物.观察两组患者的基础资料、平均SAS分值、静推咪达唑仑的次数和总量、有效镇静的比率、最高的NRS分值、静推吗啡的次数,比较两组患者的ICU住院天数、机械通气时间、停用镇静药物后撤机时间、停药后的拔管时间、谵妄和心血管不良事件的发生率.结果 两组患者镇静效果比较差异无统计学意义（P〉0.05）;右美托咪定的镇痛效果优于单独应用咪达唑仑（P〈0.05）;右美托咪定组患者停药后撤机时间、拔管时间短于咪达唑仑组（P〈0.05）,而两组患者的ICU住院天数、机械通气时间及心血管不良事件的发生率比较差异无统计学意义（P〉0.05）;右美托咪定组患者谵妄的发生率低于咪达唑仑组（P〈0.05）.结论 右美托咪定用于术后机械通气患者的镇静镇痛治疗是安全、有效的,并能缩短撤机和拔管时间,减少谵妄的发生.Objective To evaluate the safety and efficacy of dexmedetomidine for short - term sedation and analgesia of postoperative patients with mechanical ventilation. Methods The randomized controlled trial was conducted. Patients in this trial were assigned to either dexmedetomidine group or midazolam group for sedation and analgesia, midazolam and morphine were used as rescue medicine. To observe the basic characteristics of patients, the average score of SAS, the frequency and total dosage of midazolam, the ratio of effective sedation, the highest score of NRS and the frequency of using morphine in two groups. To compare the duration of mechanical ventilation, the length of stay in the ICU, the time of weaning and extubation, the incidences of delirium and cardiovascular adverse events of the two groups. Results There was no significant difference in the effectiveness of sedation in the two groups. The effectiveness of analgesia was better in dexmedetomidine group than in midazolam group ; the time of weaning and extubation was shorter in dexmedetomidine group than in midazolam group, but there were no differences in the duration of mechanical ventilation, the length of stay in the ICU, and the incidence of cardiovascular adverse events of the two groups, the incidences of delirium was lower in the dexmedetomidine group than in midazolam group. Conclusion Sedation and analgesia with dexmedetomidine is safety and effectiveness in postoperative patients with mechanical ventilation, which can shorten the time of weaning and extubation and reduce the incidences of delirium.

关 键 词：右美托咪定 机械通气 镇静 镇痛 

分 类 号：R472.9[医药卫生—护理学]