右美托咪啶治疗苯丙胺类药物急性中毒的疗效初探

Dexmedetomidine injection for acute poisoning of amphetamine

目的研究右美托咪啶治疗苯丙胺类药物急性中毒兴奋期的疗效及其安全性。方法按序贯试验研究方法将30例急性苯丙胺类中毒兴奋期患者分为咪达唑仑组(C)与右美托咪啶组(DEX)。2组患者分别在基础治疗上分别加用咪达唑仑与右美托咪啶。对比2组患者治疗前(T0)、治疗后30 min(T1)、3 h(T2)、6 h(T3)呼吸频率(RR)、平均动脉压(MAP)、心率(HR)、Ramsey镇静评分以及心律失常发生率,治疗前后血浆磷酸肌酸同工酶(CKMB)和血清肌钙蛋白I(cTnI)的水平。结果DEX组在T2、T3时的MAP、HR、RR较C组明显降低,在T3发生心律失常比例低于C组,而镇静作用达标率高于C组,比较有统计学差异(P<0.05);治疗后cTnI水平DEX组较C组低,在T3时差异有统计学意义(P<0.05)。结论右美托咪啶较咪达唑仑能更有效的控制急性苯丙胺类中毒所致的兴奋、焦虑状态,减少心律失常发生率并减轻心肌损害。

Objective To evaluate the effectiveness and safety of treatment for the acute poisoning of amphetamine using dexmedetomidine. Methods Thirty patients with acute poisoning of amphetamine were divided into the midazo- lam group （C group, n=15） and a dexmedetomidine group （DEX group, n= 15） according to sequential trial. Midazolam or dexmedetomidine to the two groups were added to on the basis of the basic therapy. The respiratory rate （RR）, MAP, HR, ramsey score, condition of arrhythmogenesis and contents of CKMB and cTnI were measured before and after the treatment at 0.5, 3, and 6 h. Results Compared with C group, RR, MAP and HR in DEX group at T2, T3 decreased significantly. The rate of frequency of arrhythmia was lower and the percent up to the standard of sedation was higher at T2 （P〈0. 05）. The content of CKMB and cTnI in DEX group were lower than that in C group at T2 （P〈0.05）. Conclusion Dexmedetomidine is more effective and safer for acute poisoning of amphetamine than midazolam in easing the status of excitement and anxiety and reducing the rate of frequency of arrhythmia and incidence of myocardial damage.