右美托咪定联合丙泊酚在ICU中的应用

Clinical Study of Dexmedetomidine Combined with Propofol for Post-Operative Patients in Intensive Care Unit

目的:探讨α2-肾上腺素受体激动剂右美托咪定(dexmedetomidine)联合丙泊酚(propofol)用于重症监护室(ICU)中术后机械通气患者的镇静效果及安全性。方法:选择术后带气管导管进入ICU继续进行机械通气治疗的患者180例,随机分为3组,每组60例,组均给予芬太尼持续静脉泵入镇痛,剂量为0.30μg/(kg.h)。右美托咪定联合丙泊酚组(简称A组)先于10 min左右缓慢静注右美托咪定0.5μg/kg,然后改用微量注射泵持续静注右美托咪定,维持量为0.10-0.20μg/(kg.h),同时静脉持续泵入丙泊酚0.10-0.30μg/(kg.h)。右美托咪定组(简称D组)先用10 min静注右美托咪定,剂量为0.50μg/kg再用微量注射泵持续静脉泵入,剂量为0.30-0.60μg/(kg.h)。丙泊酚组(简称P组):先静注丙泊酚0.3-0.6 mg/kg,注药时间60 s,然后以微量注射泵持续泵入维持剂量为0.30-1.20 mg/(kg.h);3组均采用Ramsay分级标准,调整剂量使患者Ramsay评分控制在Ⅲ-Ⅳ级。分别记录起效时间,维持镇静的剂量,药物对呼吸、循环(RR、SPO2、HR、MAP)等的影响,苏醒拔管时间,不良反应发生情况及患者舒适度。结果:3组药物均能达到ICU病人所需的镇静效果。A组较P组循环波动少、丙泊酚用量少。患者谵妄、恶心呕吐等不良反应少,差异有统计学意义(P<0.05);A组较D组右美托咪定用量少,两组在心率、血压、呼吸等方面差异均无统计学意义(P>0.05)。拔管所需时间:P组与A组、D组相比,拔管所需时间差异有统计学意义(P<0.05)。结论:右美托咪定联合丙泊酚对ICU机械通气患者镇静效果满意,减少丙泊酚及右美托咪定的用量,血流动力学稳定,无呼吸抑制,不良反应低,经济适用。

Objective： To evaluate the sedative effect and safety of dexmedetomidine combined with propofol for post-operative patients undergoing mechanical ventilation（MV） in intensive care unit（ICU）.Methods： A total of 180 cases of post-operative patients undergoing MV with tracheal intubation in ICU were divided randomly and equally into three groups as dexmedetomidine plus propofol group（group A）,dexmedetomidine group（group D）,and propofol group（group P）.In all groups fentanyl was given intravenously continually for analgesia,dose of fentanyl was kept on 0.30 μg/（kg·h）.The dose of sedation was regulated according to Ramsay sedative scores maintaining in 3-4 sedative score.During the course,anesthesia up effect time,sedation dose,awakening time,heart rate（HR）,mean artery pressure（MAP）,respiratory rate（RR）,pulse oxygen saturation（SPO 2）,adverse reactions were observed and recorded continuously.Results： All groups could reach the goal of sedation needed for ICU patients.Changes of the circulatory system and the dosage of propofol in group A were less than in group P,and there were less adverse reactions in group A than in group P（P〈0.05）.The dosage of dexmedetomidine in group A was less than in group D.There was no significant difference in HR,MAP,RR,and SPO 2 between groups A and D（P〈 0.05）.There was significant difference in extubation time between groups P and A or D（P〈0.05）.Conclusion： Dexmedetomidine combind with propofol can reach the goal of sedation needed for ICU patients,it helps to shorten the dosage of dexmedetomidine and propofol,maintains the respiratory and circulation parameters,and reduces adverse reactions.