异丙酚和右美托咪定镇静对重症患者并发急性循环衰竭时容量反应性的影响  

Effects of sedation with propofol or dexmedetomidine on volume responsiveness in critically ill patients with acute circulatory failure

作　　者：于涛[1,2] 黄英姿[1] 郭凤梅[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院重症医学科,南京市210009 [2]皖南医学院第一附属医院弋矶山医院重症医学科

出　　处：《中华麻醉学杂志》2015年第5期593-597,共5页Chinese Journal of Anesthesiology

基　　金：国家临床重点专科建设项目（2100299）;江苏省“科教兴卫工程”医学重点学科项目（889-KJXW11.3）;卫生公益性行业科研专项经费项目（201202011）

摘　　要：目的：探讨异丙酚和右美托咪定镇静对重症患者并发急性循环衰竭时容量反应性的影响。方法选择并发急性循环衰竭的重症患者91例，年龄20～90岁，体重40～80 kg，性别不限，急性生理与慢性健康评分12～47分、序贯器官衰竭评分1～18分，心功能分级Ⅰ或Ⅱ级，采用随机数字表法，将患者分为2组：异丙酚镇静组（ P组，n＝45）和右美托咪定镇静组（ D组，n＝46）。于异丙酚或右美托咪定镇静前和给予异丙酚或右美托咪定后镇静躁动评分达－2或－1分（ BIS值60～75）时（镇静后）行被动抬腿试验（ PLR），以PLR后CI增加（ΔCI）≥10％为容量反应性阳性，ΔCI＜10％为容量反应性阴性。将镇静前容量反应性阴性的患者设定为容量反应性阴性亚组（ N亚组），即PN亚组和DN亚组。结果 PN组和DN组镇静后容量反应性阳性率分别为64％（14例）和25％（5例）。与镇静前比较，PN组和DN组镇静后容量反应性阳性率升高（ P＜0．05）；与DN组比较，PN组镇静后容量反应性阳性率升高（ P＜0．05）。结论对于容量反应性阴性的并发急性循环衰竭的重症患者，异丙酚和右美托咪定镇静均可改善其容量反应性，而异丙酚的效果优于右美托咪定。Objective To evaluate the effects of sedation with propofol or dexmedetomidine on volume responsiveness in critically ill patients with acute circulatory failure. Methods Ninety-one critically ill patients with acute circulatory failure, aged 20-90 yr, weighing 40-80 kg, requiring sedation with propofol or dexmedetomidine, of Acute Physiology and Chronic Health Evaluation Ⅱ scores 12-47, of Sequential Organ Failure Assessment scores 1-18, and of NYHA Ⅰ or Ⅱ, were included. The patients were randomly divided into 2 groups using a random number table： propofol group （ n = 45 ） and dexmedetomidine group （ n=46） . Before and after propofol or dexmedetomidine sedation, when Richmond Agitation Sedation Scale score reached -2 or -1 （ BIS value 60-75） （ after sedation） , passive leg-raising （PLR） test was performed to evaluate volume responsiveness. An increase in cardiac index （ΔCI） ≥10% after PLR was considered to be a positive response, whereas ΔCI〈10% after PLR was considered to be a negative response. The patients who presented with negative responses before sedation served as negative volume responsiveness subgroups （ N subgroups ） , that was PN subgroup and DN subgroup. Results The positive rates of volume responsiveness were 64% （ 14 cases） and 25% （ 5 cases） in PN and DN subgroups, respectively. The positive rates of volume responsiveness were significantly higher after sedation than before sedation in PN and DN subgroups. Compared with DN subgroup, the positive rates of volume responsiveness were significantly increased after sedation in PN subgroup. Conclusion For the critically ill patients with acute circulatory failure, both propofol and dexmedetomidine sedation can improve volume responsiveness, and propofol provides better efficacy than dexmedetomidine.

关 键 词：二异丙酚 右美托咪啶 危重病 休克 补液疗法 

分 类 号：R614[医药卫生—麻醉学]