脓毒症休克患者中应用右美托咪定对去甲肾上腺素维持血压的影响  

The Effect of Dexmedetomidine Sedation on Norepinephrine whileMaintaining Blood Pressure in Septic Shock Patients

作　　者：胡子龙 张志成 李大伟 帅维正 邹剑锋 李哲 李琦 HU Zilong;ZHANG Zhicheng;LI Dawei;SHUAI Weizheng;ZOU Jianfeng;LI Zhe;LI Qi(Department of intensive care unit,the Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第六医学中心重症医学科,北京100048

出　　处：《转化医学杂志》2021年第2期93-96,共4页Translational Medicine Journal

摘　　要：目的在脓毒症休克患者中轮替使用丙泊酚和右美托咪定镇静,评估右美托咪定对去甲肾上腺素(Norepinephrine,NE)维持血压的影响。方法观察46例脓毒症休克患者24 h,在充分液体复苏基础上应用NE维持平均动脉压(Mean Arterial Pressure,MAP)65~70 mmHg,并应用镇静药维持镇静水平在RASS评分(Richmond Agitation-Sedation Scale,RASS)-3分~-4分。0~8 h阶段泵入丙泊酚,8~16 h阶段更换为右美托咪定,16~24 h阶段再次换回丙泊酚。记录8、16、24 h时的MAP、心率(Heart Rate,HR)、中心静脉压(Central Venous Pressure,CVP)、心指数(Cardiac Index,CI)、全身血管阻力指数(Systemic Vascular Resistance Index,SVRI)、乳酸(lactate,Lac)和各8 h阶段内液体出入量(I/O,Input/Output Balance),以及各观察节点时镇静药和NE泵入剂量。结果8、16、24 h时的MAP、HR、CVP、CI、SVRI、Lac和芬太尼剂量以及各阶段I/O无统计学差异(P>0.05)。8 h和24 h时丙泊酚剂量和NE剂量均无统计学差异(P>0.05)。16 h时右美托咪定剂量为0.80[0.75,0.80]μg/(kg·h)。NE剂量为(0.44±0.08)μg/(kg·min),与8、24 h时相比明显减少(P<0.05)。结论在维持相同血压及镇静水平条件下,相较于丙泊酚,右美托咪定能够减少NE应用的剂量。Objective Evaluating the effect of dexmedetomidine on norepinephrine in septic shock patients by using propofol or dexmedetomidine in turn for sedation.Methods We had observed 46 enrolled septic shock patients for 24 hours who were initially received adequate volume resuscitation in the course of applied norepinephrine(NE)for maintaining mean arterial pressure between 65~70 mmHg,meanwhile sedative was applied for maintaining the depth of sedation maintaining the Richmond Agitation-Sedation Scale scores-3~-4.On the purpose of sedation we used propofol at the first phase(0~8 h),then shifted to dexmedetomidine in the middle phase(8 h~16 h),thereafter turn back to propofol at the last phase(16~24 h).MAP records,heart rate(HR),central venous pressure(CVP),cardiac index(CI),systemic vascular resistance index(SVRI),lactate(Lac),dosage of sedatives and NE at the point of time 8 h,16 h and 24 h were evaluated.Besides,the fluid input/output balance(I/O)in each 8 h phase was examined,too.Results In addition to I/O in each phase,there are no statistical differences in MAP,HR,CVP,CI,SVRI,Lac and dosage of fentanyl at the three time points(P>0.05),the dosage of propofol and NE was unchanged at the time point 8 h and 24 h(P>0.05).At the time point 16 h,the dosage of dexmedetomidine was 0.80[0.75,0.80]μg/(kg·h),NE was declined to 0.44±0.08μg/(kg·min)compared with those of time point at 8 h and 24 h(P<0.05).Conclusion In the condition of maintaining same level of MAP and depth of sedation,dexmedetomidine can contribute to decreasing the dosage of NE compared with propofol in septic shock patients.

关 键 词：脓毒症休克 去甲肾上腺素 Α2肾上腺素能受体激动剂 

分 类 号：R459.1[医药卫生—治疗学]