右美托咪定对重症睡眠呼吸暂停综合征患者术后镇静作用的研究

Study of sedation with dexmedetomidine in postoperative patients with severe obstructive sleep apnea syndrome

目的了解右美托咪定(DMED)对重症睡眠呼吸暂停综合征(OSAS)患者生命体征、气管插管时间、机械通气(MV)时间、睡眠等方面的镇静作用。方法 2011年1月至2011年9月解放军总医院附属第一医院ICU收治的OSAS患者60例,随机分为右美托咪定组(D组)、丙泊酚组(P组)、咪唑安定组(M组),每组20例,分别采取相应的药物进行镇静。患者安睡可唤醒并配合时撤除机械通气,术后6h酌情拔除气管插管。记录每小时及拔管前后心率(HR)、呼吸频率、血压(SBP)和带气管插管时间、MV时间,记录患者对带管期间睡眠的评价。结果给予镇静药物后10min、拔管前,D组较P、M组HR下降(P<0.05或P<0.01),拔管后D组较P组HR降低(P<0.01)。给药10min P组和M组较D组的呼吸频率也明显下降(P<0.01)。与P组和M组比较,D组SBP在给药后10min明显升高(P<0.05或P<0.01),给药后2h则明显降低(P<0.05),拔管前D组SBP较P组明显下降(P<0.01)。各组气管插管时间无明显差异。D组MV时间较P、M组均有所下降(P<0.01)。患者对带气管插管期间的睡眠评价,以D组最为满意(P<0.05)。结论 DMED用于OSAS患者术后镇静可缩短机械通气时间,增加睡眠满意度。

Objective To observe the sedative effect of dexmedetomidine（DMED） on vital sighs,endotracheal intubation（EI） duration,duration of mechanical,and sleep in patients with severe obstructive sleep apnea syndrome（OSAS）.Methods 60 patients with OSAS were randomly divided into DMED（D） group,propofol（P） group or midazolam（M） group with 20 patients in each group.Mechanical ventilation（MV） was weaned when patients had quiet sleep and were arousal and cooperative,and tracheal cannula was extubated 6 hours after operation according to patients＇ condition.Heart rate（HR）,respiratory rate（RR） and systolic blood pressure（SBP） were recorded hourly till extubation.Duration of intubation and of MV,and subjective evaluation of sleep during intubation were also recorded.Results 1） HR in D group decreased much significantly than that in P and M group 10 minutes after administration and before excubation（P0.01 or 0.05） and it decreased than that in P group（P0.01） before excubation.RR in P and M group decreased than that in D group 10 minutes after administration（P0.01）.SBP in D group increased than that in P and M group10 minutes after administration（P0.05 or P0.01）,whereas it decreased than that in P and M group 2 hours after administration（P0.05）.Before excubation,SBP in D group decreased than that in P group（P0.01）.2） Duration of EI had no difference among groups,but duration of MV in D group decreased much significantly than that in P and M group（P0.01）.3） Patients in D group had most satisfactory sleep during EI（P0.05）.Conclusion Sedation with dexmedetomidine in postoperative patients with severe OSAS could shorten duration of MV,and conduce to more satisfactory sleep.