右美托咪定与丙泊酚对心脏瓣膜术后机械通气患者镇静效果及血流动力学的影响  

Effect of dexmedetomidine and propofol on sedation and hemodynamics of patients undergoing mechanical ventilation after cardiac valve surgery

作　　者：王婧[1] 奚望[1] 殷亮[1] 李伟[1] 申华[1] 王志农[1] 

机构地区：[1]第二军医大学长征医院胸心外科,上海200003

出　　处：《第二军医大学学报》2017年第5期563-569,共7页Academic Journal of Second Military Medical University

摘　　要：目的比较右美托咪定与丙泊酚对心脏瓣膜术后机械通气患者的镇静效果及血流动力学的影响。方法选取60例心脏瓣膜术后机械通气患者,随机分为右美托咪定组(D组)30例和丙泊酚组(P组)30例,D组给予右美托咪定0.2~0.7μg/(kg·h)+舒芬太尼0.15μg/(kg·h),P组给予丙泊酚1.2~3.0 mg/(kg·h)+舒芬太尼0.15μg/(kg·h)。以脑电双频指数(BIS)值为70~85、Richmond躁动镇静评分(RASS)-2^-3分为镇静目标。分别于术前(T_1)、心肺转流(CPB)结束后2 h(T_2)、术后4 h(T_3)和术后12 h(T_4)测定患者血流动力学相关指标。比较两组患者各观察时间点的BIS值、RASS评分以及平均动脉压(MAP)下降、心动过缓、躁动或谵妄等不良反应发生率。结果两组患者镇静后的BIS值与RASS评分差异无统计学意义(P>0.05)。两组患者镇静后血流动力学变化存在差异,MAP有不同程度的下降,在T_2时间点,P组的MAP小于D组(P<0.05);在T_3、T_4时间点,D组心指数(CI)高于P组(P<0.05,P<0.01)。在T_2、T_3、T_4时间点,P组的动脉血乳酸含量较D组升高明显(P<0.05,P<0.01)。两组间T_1~T_4各时点的全身血管阻力指数(SVRI)、每搏输出量(SV)、右心室射血分数(RVEF)、混合静脉血氧饱和度(Sv O2)差异无统计学意义(P>0.05)。两组各血管活性药物用量差异无统计学意义(P>0.05)。两组患者术后MAP下降、心动过缓发生率差异无统计学意义(P>0.05),D组镇静过程中躁动及谵妄发生率低于P组(P<0.05)。结论两组患者均可取得较好的镇静效果。右美托咪定对血流动力学影响较小,且其用于术后镇静可降低躁动或谵妄的发生率。右美托咪定更适合用于心脏瓣膜术后镇静。Objective To compare the effects of dexmedetomidine and propofol on sedation and hemodynamics of patients undergoing mechanical ventilation after cardiac valve surgery. Methods Sixty patients who received mechanical ventilation after cardiac valve surgery were randomly divided into dexmedetomidine group （Group D, n=30） and propofol group（Group P, n=30）. The patients in group D received the sedation formula of dexmedetomidine 0.2-0.7 μg/（kg·h） and sufentanil 0.15 μg/（kg·h）, while those in group P received the sedation formula of propofol 1.2-3.0 mg/（kg·h） and sufentanil 0.15 μg/（kg·h）. The dose of sedation was regulated in order to maintain bispectral index （BIS） score at 70-85 and Richmond agitation-sedation scale （RASS） at -2——3. Hemodynamic parameters of the patients were assessed at pre-operation （T1）, 2 h post-cardiopulmonary bypass （CPB, T2）, 4 h post-operation （T3） and 12 h post-operation （T4）. We compared and analyzed the sedation scores of BIS and RASS, and incidences of complications such as mean arterial pressure （MAP） decrease, bradycardia, delirium or agitation of the patients in two groups. Results There was no significant difference between two groups in BIS score and RASS score （P〉0.05）. There was a significant difference in hemodynamics change between the two groups. The MAP in Group P was significantly lower than that in Group D at T2 （P〈0.05）. The cardiac index in Group D was significantly higher than that in Group P at T3 （P〈0.05） and T4 （P〈0.01）. Arterial blood lactate contents in Group D were significantly lower than that in Group P at T2, T3 and T4 （P〈0.05, P〈0.01）.There was no significant difference between two groups in systemic vascular resistance index, stroke volume, right ventricular ejection fraction or oxygen saturation of mixed venous blood （P〉0.05）. The vasoactive agent dosages were not different between two groups （P〉0.05）. There was no significant difference between two grou

关 键 词：右美托咪定 丙泊酚 血流动力学 心脏瓣膜手术 机械通气 镇静 

分 类 号：R654.27[医药卫生—外科学]