盐酸右美托咪定在胸外手术中机械通气撤离时的临床应用分析

Clinical application of dexmedetomidine hydrochloride in mechanical ventilation withdrawal for patients underwent thoracic surgery

目的:探讨盐酸右美托咪定在胸外手术中机械通气撤离期患者的镇静效果及安全性。方法:选取我院接受胸外手术进行机械通气的患者100例为研究对象,其中对照组50例接受咪达唑仑注射,并在机械通气撤离前1h停用咪达唑仑;实验组50例接受盐酸右美托咪定注射,在机械通气撤离后停用盐酸右美托咪定。两组均依据Ramsay评分以及不同时间测定的不同时点心率(HR)、平均动脉压(MAP)、自主呼吸(R)等各项生命指标。结果:两组用药10min后均达到理想镇静效果,机械通气撤离前1h对照组Ramsay评分降至Ⅰ～Ⅱ级,实验组Ramsay评分为Ⅲ～Ⅳ级;机械通气撤离后实验组Ramsay评分明显高于对照组(t=4.573,P<0.05);两组在用药后至机械通气撤离1h,HR、MAP、R等指标差异无统计学意义(P>0.05),通气撤离后两组上述指标比较差异有统计学意义(P均<0.05)。结论:盐酸右美托咪定应用于胸外手术机械通气患者其镇静效果良好,拔管反应得到有效、安全抑制,并且拔管前、后呼吸及血液动力学指标均稳定,具有广泛临床应用前景。

Objective. To investigate the anesthesia effects of dexmedetomidine hydrochloride in mechanical ventilation withdrawal for patients underwent thoracic surgery and its safety. Methods. A total of 100 patients that underwent mechanical ventilation during thoracic surgery were enrolled as study group, of which 50 （control group） were assigned to have midazolam injection, which was withdrawn lh before weaning from mechanical ventilation, while the other 50 （study group） were given dexmedetomi- dine hydrochloride injection until the withdrawal of mechanical ventilation. The Ramsay score, heart rate （HR） at different time points, mean arterial pressure （MAP）, Spontaneous breathing （R） and other vitalindexes were compared between the two groups. Results. After 10 minutes of administration, anesthesia effects were satisfied in both groups, lh before the withdrawal of mechanical ventilation, Ramsay scores of the control group and study group were Ⅰ-Ⅱ and Ⅲ to Ⅳ grade, respectively, after removal of mechani- cal ventilation, Ramsay scores of the study group was significant higher than that of the control group （t= 4. 573, P〈0.05）. No significant difference in HR, MAP, R and other indicators were observed 1 h before the withdrawal of mechanical ventilation, but after removal of mechanical ventilation, those indicators were all significant different between the two groups （P all 〈 0. 05）. Conclusions. Dexmedetomidine hydrochloride shows great anesthesia effects in mechanical ventilation withdrawal for patients underwent thoracic surgery and it can suppress adverse reactions and keep respiratory and hemodynamic indexes sta- ble during the process of withdrawal of mechanical ventilation, it＇s worthy of application in large scale.