ICU机械通气患者右美托咪定镇静的安全性评价  

Safety evaluation of dexmedetomidine sedation in ICU patients undergoing mechanical ventilation

作　　者：杨明全[1] 周洁[1] 曹建伟[1] 曾永红[1] 郑刚[1] 

机构地区：[1]自贡市第一人民医院ICU,四川自贡643000

出　　处：《中华危重病急救医学》2016年第9期839-844,共6页Chinese Critical Care Medicine

基　　金：四川省医药卫生科研课题（120003）

摘　　要：目的观察重症加强治疗病房（ICU）机械通气患者使用右美托咪定镇静时心血管等不良事件的发生情况，以评价其安全性。方法采用前瞻性随机对照研究方法，人选四川省自贡市第一人民医院ICU收治的机械通气时间≥48h的成人重症患者。按计算机产生的随机序号将患者分为右美托咪定组（Dex组）和咪达唑仑组（Mid组）。两组患者均采用咪达唑仑0．05mg／kg＋芬太尼1～2μg／kg缓慢静脉推注诱导麻醉行气管插管，然后以咪达唑仑0．06mg·kg-1·h-1＋芬太尼20—50μg·kg-1·h-1或舒芬太尼0．1～0．2μg·kg-1·h-1持续静脉泵入维持镇痛镇静；次日，Dex组给予右美托咪定（起始量0．4μg·kg-1·h-1，维持量0．1～0．7μg·kg-1·h-1）30min后停用咪达唑仑；Mid组保持原有镇静镇痛方案不变。镇静目标为Richmond躁动一镇静评分（RASS）维持在-2～1分或Ramsay镇静评分维持在3～4分；患者如果出现明显躁动则给予咪达唑仑，必要时联合丙泊酚镇静；每Et进行唤醒试验。观察终点为患者转出ICU、死亡或机械通气时间≥28d。观察两组患者镇静期间高血压、低血压、心动过缓、心动过速、心律失常等心血管不良事件的发生情况，镇静镇痛药物用量，机械通气时间、ICU住院时间及28d病死率。结果共纳入383例患者，Dex组190例，Mid组193例。两组患者性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、预计病死率等一般资料比较差异均无统计学意义。Dex组咪达唑仑、丙泊酚及芬太尼用量均较Mid组减少，两组舒芬太尼用量基本相似。Dex组Ramsay和RASS评分均较Mid组明显降低（分：3．34±0．63比3．95±0．86，-1．33±0．87比-1．98±1．27，均P〈0．01）。Dex组以心率（HR）减慢为突出表现，51．1％的患者用药之初（1～2h）即表现为HR减慢；HR〈50次／min需异丙肾上腺素处理者比Mid组少�Objective To observe the occurrence of cardiovascular adverse events in patients undergoing mechanical ventilation with dexmedetomidine sedation, and to evaluate its safety in intensive care unit （ICU）. Methods A prospective randomized controlled trial was conducted. Adult critical patients undergoing mechanical ventilation over 48 hours admitted to ICU of Zigong First People＇s Hospital in Sichuan Province were enrolled. The patients were divided into dexmedetomidine group （Dex group） and midazolam group （Mid group） according to the randomise number generated by computer. The patients in both groups were given slow intravenous infusion of 0.05 mg/kg midazolam and 1-2 p.g/kg fentanyl to induce anesthesia before tracheal intubation, followed by 0.06 mg·kg-1·h-1midazolam and 20-50μg·kg-1·h-11 fentanyl or 0.1-0.2μg·kg-1·h-1sufentanil for continuous intravenous pumping to maintain analgesia and sedation; on the next day, the patients in Dex group was given dexmedetomidine （with the initial dose of 0.4μg·kg-1·h-1, and maintenance dose of 0.1-0.7μg·kg-1·h-1）, and midazolam was stopped half an hour later; the original sedation and analgesia plan remained unehanged in Mid group. The goal of sedation was to maintain a Richmond agitation-sedation scale （RASS） score of -2 to 1 or a Ramsay sedation seore of 3 to 4; patients were given midazolam if obvious agitation occurred, in combination with propofol for sedation if neeessary; wake- up test was performed every day. Observation endpoints included patients discharged from ICU, death or mechanical ventilation over 28 days. Occurrence of cardiovascular adverse events during sedation such as hypertension, hypotension, bradycardia, tachycardia and arrhythmia, dose of sedatives and analgesics, duration of mechanical ventilation, length of ICU stay and 28-day mortality were observed in two groups. Results A total of 383 patients were enrolled, with 190 patients in Dex group and 193 in Mid group. There was no statistically significant difference

关 键 词：机械通气 右美托咪定 咪达唑仑 镇静 不良事件 安全性 

分 类 号：R614[医药卫生—麻醉学]