右美托咪定联合布托啡诺用于重症加强治疗病房患者镇静的临床研究  

Clinical effect of dexmedetomidine hydrochloride injection combined with butorphanol conventional therapy on sedation of intensive care unit patients

作　　者：孔令贵[1] 文辉[1] 刘观斌[1] 赵猛[1] 宋淑玲[1] 吴霞[1] 

机构地区：[1]山东省滨州市中心医院,山东滨州251700

出　　处：《中国中西医结合急救杂志》2015年第5期524-526,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的 观察右美托咪定联合布托啡诺用于重症加强治疗病房（ICU）患者持续镇静的效果.方法 选择2014年6月至9月山东省滨州市中心医院收治的重症患者60例,按随机数字表法分为试验组和对照组,每组30例.对照组单独给予0.8 mg/L右美托咪定（400μg加46 mL生理盐水配成50 mL）,以 0.4μg·kg^-1·h^-1的速度微量泵持续静脉输注镇痛、镇静;试验组给予右美托咪定联合200 mg/L布托啡诺（10 mg 加40 mL生理盐水配成50 mL）,以0.01 mg·kg^-1·h^-1的速度微量泵持续静脉输注48 h镇痛、镇静.两组均维持镇静以达到Ramsay评分3～5分.观察两组患者治疗前后心率（HR）、呼吸频率（RR）、平均动脉压（MAP）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、脉搏血氧饱和度（SpO2）的变化;比较两组右美托咪定维持用量、面部表情评分法（FPS）评分及Ramsay评分;并评价两组患者的临床疗效.结果 两组治疗后患者的HR、MAP、RR均较治疗前明显降低,PaO2、SpO2均较治疗前明显升高,且试验组上述指标的改善程度较对照组更优〔HR（次/min）：84.58±12.43比118.62±14.21,MAP（mmHg,1 mmHg=0.133 kPa）：82.35±12.12比92.35±12.32,RR（次 /min）：25.42±3.98 比 32.87±5.12,PaO2（mmHg）：95.21±10.55 比 75.18±8.57,SpO2：0.981 4±0.102 8比0.954 7±0.093 8,均P〈0.05〕.试验组总有效率明显高于对照组〔93.3%（28/30）比76.7%（22/30）,P〈0.05〕.试验组右美托咪定用量较对照组明显减少（μg/d：412.12±23.18比520.05±15.68,P〈0.05）;FPS评分较对照组明显降低（1.48±0.16比2.52±0.74,P〈0.05）.结论 右美托咪定联合布托啡诺应用于ICU患者可减少右美托咪定用量,Ramsay评分理想,血压更平稳,有良好的镇痛、镇静效果.Objective To investigate the effect of dexmedetomidine combined with butorphanol conventional therapy on sustaining sedation of intensive care unit （ICU） patients.Methods Sixty critically ill patients in Binzhou Central Hospital from June to September in 2014 were randomly divided into experimental group and control group, 30 cases in each group. In the control group, 0.8 mg/L dexmedetomidine hydrochloride injection （400μg with addition of 46 mL normal saline to form 50 mL solution） was intravenously infused continuously at a speed of 0.4μg·kg^-1·h^-1 by a micro-pump to induce analgesia and sedation; while in the experimental group, dexmedetomidine combined with 200 mg/L butorphanol （10 mg plus 40 mL normal saline to form 50 mL solution） was given for intravenous infusion by a micro-pump with a speed of 0.01 mg·kg^-1·h^-1 to maintain analgesia and sedation for 48 hours whose required Ramsay score in both groups was 3 - 5. Before and after treatment, the changes of heart rate （HR）, respiratory rate （RR）, mean arterial pressure （MAP）, arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon dioxide （PaCO2）, and the pulse oxygen saturation （SpO2） of both groups were observed. The dosage of dexmedetomidine used for maintenance of required analgesia and sedation and FPS （facial expression） grading and Ramsay score were compared respectively between the two groups, and the clinical efficacy of the two groups were evaluated.Results After treatment, the HR, MAP, RR in both groups were significantly lower, and PaO2 and SpO2 were significantly higher than those before treatment, and the degrees of improvement in the above indexes of the experiment group were superior to those of the control group [HR （bpm）： 84.58±12.43 vs. 118.62±14.21, MAP （mmHg, 1 mmHg = 0.133 kPa）： 82.35±12.12 vs. 92.35±12.32, RR （times/min）： 25.42±3.98 vs. 32.87±5.12, PaO2 （mmHg）： 95.21±10.55 vs. 75.18±8.57, SpO2： 0.981 4±0.102 8 vs. 0.954 7±0.093 8

关 键 词：右美托咪定 布托啡诺 镇静 

分 类 号：R454[医药卫生—治疗学]