右美托咪定与丙泊酚对脓毒症患者腹内压的影响

Effects of dexmedetomidine versus propofol on intraabdominal pressure in the patients with sepsis

目的比较右美托咪定与丙泊酚对脓毒症患者腹内压(IAP)的不同影响。方法将腹部手术术后需行机械通气的合并脓毒症的肠梗阻患者随机分入右美托咪定组和丙泊酚组,每组20例。丙泊酚组于15min内静脉注射丙泊酚1mg/kg,随后以3mg·kg-1·h-1的剂量持续静脉滴注维持。右美托咪定组于10min静脉注射右美托咪定1μg/kg,随后以0.2～0.25μg·kg-1·h-1的剂量予持续静脉滴注维持。两组患者镇静持续时间均>24h。分别记录患者镇静治疗前、镇静后24及48h的IAP水平。结果右美托咪定组于镇静后24及48h的IAP水平分别为(12.25±5.73)和(13.8±6.05)mmHg(1mmHg=0.133kPa),显著低于丙泊酚组同时间点的(18.1±2.73)和(18.6±3.35)mmHg(P值均<0.05)。结论与丙泊酚相比,右美托咪定可以更有效地降低严重脓毒症患者的IAP。

Objective To compare the effects propofol with dexmedetomidine on intraabdominal pressure in the patients with sepsis after abdominal surgery. Methods Forty patients undergoing surgical treatment for intestinal obstruction and were expected to require postoperative sedation and mechanical ventilation were enrolled in this study. The patients received either a loading dose of propofol （1 mg/kg, n = 20） in 15 mins followed by a maintenance dose of 3 mg · kg-1· h-1 or a loading dose of dexmedetomidine （1 μg/kg, n = 20） in 10 mins followed by a maintenance dose of 0.2-2.5 μg · kg-1 ·h-1 for over 24 h. Intraabdominal pressure was recorded before injection and at 24 h and 48 h after injection. Results Intraabdominal pressure in dexmedetomidine group was significantly lower than that in propofol group at 24 h （[12.25 ±5.73] mmHg vs. [18. 1 ± 2.73] mmHg [1 mmHg=0. 133 kPa]） and 48 h （[13.8±6.05] mmHg vs. [18.6 ± 3.35] mmHg） after injection （both P〈 0.05）. Conclusion Dexmedetomidine can significantly decrease intraabdomina, pressure compared with propofol for the patients with severe sepsis.