右美托咪定对急性主动脉夹层患者镇痛和镇静的影响:前瞻性随机对照研究  

Effect of Dexmedetomidine on Analgesia and Sedation in Patients With Acute Aortic Dissection:a Prospective Randomized Controlled Study

作　　者：郭文静 胡杰[1] 陈兴澎[1] Guo Wenjing;Hu Jie;Chen Xingpeng(Heart Center, Luoyang Central Hospital, Luoyang 471000, China)

机构地区：[1]洛阳市中心医院心脏中心,洛阳471000 [2]新乡医学院,新乡453004

出　　处：《中国微创外科杂志》2020年第5期397-400,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省科技发展计划项目(192102310128);洛阳市科技攻关重大项目(1716001A)。

摘　　要：目的探讨右美托咪定(dexmedetomidine,Dex)对急性主动脉夹层(aortic dissection,AD)患者镇痛和镇静的有效性及安全性。方法选取2018年10月~2019年10入住我院ICU急性AD 50例,按随机数字表分为对照组和右美托咪定组,对照组常规吗啡、硝普钠和艾司洛尔降血压、控制心率(heart rate,HR);右美托咪定组除常规吗啡、硝普钠降压外,静脉泵入Dex 1.0μg·kg^-110 min后,持续静脉泵入Dex 0.3μg·kg^-1·h^-1维持,HR控制不良加用艾司洛尔。根据患者血压、HR调整泵药量,控制收缩压(systolic blood pressure,SBP)在120 mm Hg以下,HR 70次/min以下。在T0(入监护室即刻),T1(治疗30 min),T2(治疗2 h),T3(治疗6 h),T4(治疗24 h)5个时间点评估患者疼痛视觉模拟评分(Visual Analogue Score,VAS)及镇静评分(Ramsay评分),记录SBP、HR、动脉血氧分压(arterial oxygen pressure,PaO2)和吗啡、艾司洛尔、硝普钠用量。结果2组患者HR、SBP、PaO2和VAS评分组间、时间、组间与时间交互差异有显著性(P<0.05);Ramsay评分组间差异无显著性(P>0.05),时间、组间与时间交互有差异(P<0.05)。右美托咪定组吗啡用量明显低于对照组[(28.3±6.8)mg vs.(65.2±10.4)mg,t=13.700,P=0.000];艾司洛尔用量显著低于对照组[(775.8±126.3)mg vs.(1944.3±314.3)mg,t=17.247,P=0.000],硝普钠用量显著低于对照组[(50.1±13.5)mg vs.(101.7±16.8)mg,t=11.971,P=0.000]。结论Dex用于急性AD患者能够快速稳定血压和HR,同时产生良好的镇痛和镇静作用,减少吗啡等药物用量,起到保护作用。Objective To investigate the effect of dexmedetomidine on analgesia and sedation in patients with acute aortic dissection(AD).Methods A total of 50 patients with acute AD admitted to ICU from October 2018 to October 2019 were randomly divided into either control group or dexmedetomidine group.In the control group,the morphine,sodium nitroprusside and esmolol were used to control blood pressure and heart rate(HR).In the dexmedetomidine group,besides routine anti-hypertensive use of morphine and sodium nitroprusside,dexmedetomidine was continuously pumped into for 10 minutes and maintained at 0.3μg·kg^-1·h^-1.The esmolol was added for heart rate control.According to the patient’s blood pressure and HR,we adjusted the dosage of the pump,controlled the systolic blood pressure(SBP)<120 mm Hg and heart rate<70 times/min.The pain Visual Analogue Score(VAS)and sedation score(Ramsay)of patients at different time points were evaluated at T0(immediately after entering the ICU),T1(30 min after treatment),T2(2 h after treatment),T3(6 h after treatment)and T4(24 h after treatment).The SBP,HR,and arterial oxygen pressure were recorded.The dosages of morphine,esmolol,and sodium nitroprusside were recorded.Results There were significant differences in HR,SBP,oxygen partial pressure,and VAS scores between the two groups,different time,and interaction between time and groups(P<0.05).There was no difference in Ramsay scores between the two groups(P>0.05),but significant differences in different time and interaction between time and groups(P<0.05).The morphine use in the dexmedetomidine group was lower than that in the control group[(28.3±6.8)mg vs.(65.2±10.4)mg,t=13.700,P=0.000],and the use of esmolol was lower than that in the control group[(775.8±126.3)mg vs.(1944.3±314.3)mg,t=17.247,P=0.000].The dosage of sodium nitroprusside in the dexmedetomidine group was lower than that in the control group[(50.1±13.5)mg vs.(101.7±16.8)mg,t=11.971,P=0.000].Conclusion Dexmedetomidine can rapidly stabilize blood pressure and HR in pa

关 键 词：右美托咪定 急性主动脉夹层 镇痛 镇静 

分 类 号：R61[医药卫生—外科学]