右美托咪啶复合盐酸瑞芬太尼在ICU高血压脑出血患者术后镇静镇痛中的应用  

Dexmedetomidine combined with remifentanil used for sedation and analgesia in ICU patients with hypertensive cerebral hemorrhage

作　　者：揭红英[1] 李云祥[1] 叶纪录[1] 

机构地区：[1]泰州市人民医院重症医学科,江苏省泰州225300

出　　处：《中华急诊医学杂志》2015年第12期1368-1372,共5页Chinese Journal of Emergency Medicine

基　　金：泰州市科技支撑项目（TS201236）

摘　　要：目的 探讨右美托咪啶复合盐酸瑞芬太尼在高血压脑出血患者术后的镇静和镇痛中的应用.方法 选取本院ICU2013年5月至2015年6月收治的高血压脑出血行开颅血肿清除术后患者60例为研究对象,随机（随机数字法）分为右美托咪定复合盐酸瑞芬太尼（D＋R,n=30）组和咪达唑仑复合盐酸瑞芬太尼（M＋R,n =30）,镇静镇痛后记录入ICU时、术后6h、术后24h、术后48 h（T0～T3）各时间点的血压、呼吸频率、氧饱和度、心率、ICP、Ramsay镇静评分、IL-1、和TNF-α水平.结果 与M＋R组相比,D＋R组患者在T2和T3时间点的MAP、RR和HR、ICP、IL-1β、TNF-α、再出血手术率、病死率均明显降低（P＜0.05）,同时Ramsay镇静评分是明显增加的（P＜0.05）,无过度镇静镇痛之虞.结论 右美托咪啶复合盐酸瑞芬太尼在控制高血压脑出血术后血压及颅内压的剧烈波动,减少患者术后再出血的发生方面具有显著的优势.Objective To explore the administration of Dexmedetomidine combined with remifentanil for sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage after operation.Methods A total of 60 patients with hypertensive cerebral hemorrhage treated with hematoma removal under craniotomy were selected from May 2013 to June 2015.The patients were randomly （random number） divided into the Dexmedetomidine combined with remifentanil group （D ＋ R, n =30）, and Midazolam combined with remifentanil group （M ＋ R, n =30）.The blood pressure, respiration rate, oxygen saturation, heart rate, ICP （intracranial pressure）, Ramsay sedation scores, and IL-1, and TNF-α levels were recorded after sedation and analgesia in ICU, and 6 h, 24 h, 48 h after operation （T0-T3）.Results Compared with M ＋R group, the MAP, RR, HR, ICP, IL-1β, TNF-α, rate of reoperation for check bleeding, and mortality were significantly decreased in D ＋ R group （P 〈 0.05）, and Ramsay sedation score was significantly increased at the same time （P 〈 0.05） without excessive sedation and analgesia noticed.Conclusions Dexmedetomidine combined with remifentanil exhibits significant benefit in many respects including control of great fluctuations of blood pressure and intracranial pressure after craniotomy, reduce the production and release of inflammatory mediators, reduce the occurrence of rebleeding after operation.It shows good controllability and safety, it is an optimal method producing sedation and analgesia in ICU patients with hypertensive cerebral hemorrhage after operation.

关 键 词：右美托咪啶 盐酸瑞芬太尼 高血压脑出血术后 再出血 脑保护 镇静 镇痛 

分 类 号：R614[医药卫生—麻醉学]