脑电双频指数引导下不同剂量右美托咪啶用于术后ICU患者镇静

Bispectral Index-guided Sedation with Different Doses of Dexmedetomidine in ICU Patients

目的:评估不同剂量右美托咪啶(dexmedetomidine,Dex)术后镇静效应和安全性。方法:选择手术后需气管插管机械通气且镇静时间小于24 h的重症监护病房(ICU)患者60例,随机双盲分为右美托咪啶1组(Dex1组)﹑2组(Dex2组)和咪达唑仑组(M组)。记录3组镇静前及镇静开始3 h各时间点脑电双频指数值(BIS)﹑Ramsay镇静评分﹑平均动脉压(MAP)和心率(HR)。3组输注开始3 h后将BIS值控制在(61～84)之间。并以此为标准调整输注剂量维持镇静过程。根据疼痛情况间断给予吗啡镇痛。记录3组机械通气时间、拔管时间、唤醒所需时间,镇静过程MAP和HR变化及吗啡使用剂量。评估记录3组患者拔管后Steward苏醒评分及谵妄等不良反应事件发生的病例数。结果:3组患者镇静效应比较,差异无统计学意义(P>0.05),右美托咪啶两组更易唤醒并保持安静。与镇静前比,镇静后各时间点BIS值显著下降,Ramsay评分显著升高,差异均有统计学意义(P<0.05)。与咪达唑仑组相比,在同一镇静水平下,右美托咪啶两组唤醒所需时间﹑拔管时间明显缩短(P<0.05),拔管后Steward苏醒评分更高(P<0.05),谵妄发生率﹑苏醒后再入睡率显著降低(P<0.05)。Dex2组患者使用吗啡的剂量明显少于另2组(P<0.05)。结论:不同剂量右美托咪啶用于ICU术后患者镇静效果好、易唤醒,苏醒质量高,谵妄及不良反应发生率低,具有良好的安全性。在脑电双频指数引导同一镇静水平下,较高剂量的右美托咪啶可能更有优势。

Objective To evaluate the postoperative efficacy and safety of Bispectral index(BIS)-guided sedation with different doses of Dexmedetomidine(Dex).Methods Sixty ICU patients of postoperation on mechanical ventilation for at least 24 hour were randomized double blindly into group Dex1,group Dex2 and group M.The BIS,Ramsay score,MAP and HR were monitored,before Dex or Mid infusion and at each point in three hours after continuous infusion.The level of BIS was kept at 61~ 84 and used as criteria to speed up or stop the infusion to maintain sedation.The intermittent injection of Morphine(Mor) was adjusted according to the degree of the pain.Recorded mechanical ventilation time,extubation time,wake time,the changes of MAP and HR,the doses of Mor among three groups.The cases of Steward awakening score and adverse events such as delirium occurred after extubation of all patients was evaluated and recorded.Results Among the three groups,there were no significantly differences in the sedative effects(P>0.05).The two groups of giving Dex were easier to wake up and keep quiet.The BIS decreased(P<0.05) and Ramsay score was higher(P<0.01) significantly compared with that before.At the same level of sedation,in group Dex1 and Dex2,compared with group M,the wake time decreased significantly(P<0.05) and the extubation time also decreased(P<0.01),after extubation Steward higher(P<0.05),the incidences of delirium and sleeping again decreased significantly,so were the doses of Mor.Conclusion The BIS guided with Dex may provide safe and effective sedation,the high quality of wake up and reduced adverse reactions such as delirium,the higher doses of Dex is more suitable for ICU patients.