右美托咪定在重症急性胰腺炎机械通气患者镇静中的应用  

Sedative effect of dexmedetomidine in severe acute pancreatitits patients undergoing mechanical ventilation

作　　者：杨芳[1] 向林[1] 张毅[1] 孙敏[1] 陈倪[1] 刘军[1] 闫芳[1] 

机构地区：[1]成都市第五人民医院重症医学科,611130

出　　处：《中国医药》2016年第1期72-75,共4页China Medicine

摘　　要：目的观察右美托咪定在重症急性胰腺炎机械通气患者镇静中的应用。方法选择 2013年12月至2014年12月入住成都市第五人民医院重症监护病房进行有创机械通气的重症急性胰腺炎患者80例，采用随机数字表法分为观察组和对照组，各40例。观察组给予右美托咪定注射液负荷量0.8～1.0 μg /kg，后以0.2～0.7 μg/（kg·h）持续静脉微泵泵入；对照组给予咪达唑仑注射液负荷量0.06 mg/kg，后以0.04～0.20 mg/（kg·h）维持；2组均根据镇静效果调整剂量。比较2组Ramsay镇静评分和给药后0、4、8、12 h的平均动脉压、心率、呼吸频率，同时观察心动过缓和谵妄发生率。结果Ramsay镇静评分3～4级比例观察组与对照组比较［90.0%（36/40）比85.0%（34/40）］，差异无统计学意义（χ^2=0.457，P＞0.05）。观察组给药后4、8 h，对照组给药后12 h的平均动脉压均明显低于给药后0 h［（83±5）、（84±4）mmHg（1 mmHg=0.133 kPa）比（88±9）mmHg，（77±6）mmHg比（85±7）mmHg］，差异均有统计学意义（均P＜0.05）。观察组给药后4、8 h和对照组给药后8 h心率明显低于给药后0 h［（85±23）、（90±24）次/min比（118±24）次/min，（100±19）次/min比（125±17）次/min］，观察组给药后4、8 h的心率均明显低于对照组，差异有统计学意义（P＜0.05）。对照组给药后4、8、12 h的呼吸频率均低于给药后0 h［（18±4）、（16±4）、（14±3）次/min比（23±5）次/min］，观察组给药后12 h呼吸频率明显高于对照组［（18±5）次/min比（14±3）次/min］，差异有统计学意义（P＜0.05）。观察组谵妄发生率明显低于对照组［7.5%（3/40）比25.0%（10/40）］，差异有统计学意义（χ^2=4.501，P＜0.05）。2组心动过缓发生率比较，差异无统计学意义（P＞0.05）。结论右美托咪定用于重症急性胰腺炎机械通气患者镇静效果满意，唤醒时间较短，对呼�ObjectiveTo observe the sedative effects of dexmedetomidine in patients with severe acute pancreatitits undergoing mechanical ventilation. MethodsEighty severe acute pancreatiitis patients undergoing mechanical ventilation in intensive care unit from December 2013 to December 2014 were randomly divided into observation group （40 cases） and control group （40 cases）. Observation group was intravenously given of dexmedetomidine [loading dose of 0.8-1.0 μg/kg followed by maintained dose of 0.2-0.7 μg/（kg·h）]; control group was intravenously given midazolam [loading dose of 0.06 mg/kg followed by maintained dose of 0.04-0.20 mg/（kg·h）]; the sedation dose was adjusted according to the effect. The Ramsay sedation score was assessed; the mean arterial pressure, heart rate and respiratory rate 0, 4, 8, 12 h after administration were compared between groups; the incidences of bradycardia and delirium were compared between groups. ResultsThe proportion of patients with Ramsay sedation score 3-4 scores were not significantly different between observation group and control group [900% （36/40） vs 85.0% （34/40）] （χ^2=0.457,P〉0.05）. Compared with 0 h after administration, the mean arterial pressure 4 and 8 h after administration in observation group and 12 h in control group after administration was significantly reduced [（83±5）, （84±4） mmHg vs （88±9） mmHg, （77±6） mmHg vs （85±7） mmHg]. Compared with 0 h after administration, the heart rate 4 and 8 h after administration in observation group and 8 h after administration in control group was significantly reduced [（85±23）, （90±24） times/min vs （118±24） times/min, （100±19） times/min vs （125±17） times/min] （P〈005）; 4 and 8 h after administration, the heart rate in observation group was significantly lower than that in control group （P〈005）. Compared with 0 h after administration, the respiratory rate 4, 8, 12 h after administration in control group was significantly reduced [（

关 键 词：重症急性胰腺炎 机械通气 右美托咪定 咪达唑仑 镇静 

分 类 号：R576[医药卫生—消化系统]