右美托咪定加芬太尼对冠心病患者术后镇静镇痛疗效观察

Postoperative sedative and analgesic effects of dexmedetomidine plus fentanyl on patients with coronary artery disease

目的探讨右美托咪定联合芬太尼对冠心病患者术后的镇静镇痛疗效。方法选择2010年1月～2012年6月在我院36例行冠心病手术患者,随机分为对照组(M组)和治疗组(D组),每组18例。M组给予咪达唑仑0.05 mg/(kg.h)+芬太尼1μg/(kg.h);D组给予右美托咪定0.6μg/(kg.h)+芬太尼1μg/(kg.h),两组分别于术后入ICU起开始用药,记录用药前和用药后4、8、12、24 h共5个时点的Ramsay镇静评分、心率、收缩压、舒张压、呼吸、脉搏氧饱和度(SpO2)、机械通气时间、ICU停留时间等指标。结果两组Ramsay镇静评分、收缩压、舒张压无显著差异(P>0.05);用药后D组HR较M组有所下降(P<0.05);D组机械通气时间及ICU停留时间明显短于M组(P<0.05),尤其是D组较M组不易产生呼吸抑制作用(P<0.05)。结论右美托咪定联合芬太尼可明显减少冠脉架桥术后患者机械通气时间、ICU停留时间,对自主呼吸无明显抑制作用,右美托咪定联合芬太尼是一种相对安全、有效的冠心病患者术后的镇静镇痛疗法。

Objective To discuss postoperative sedative and analgesic effects of dexmedetomidine plus fentanyl on patients with coronary artery disease.Methods Thirty six patients receiving operation on coronary artery disease from January 2010 to June 2012 were randomly divided into two groups,i.e.control group（group M） and treatment group（group D） with 18 cases in each group.Group M received midazolam 0.05 mg /（kg.h） plus fentanyl 1 μg /（kg.h）,while group D received dexmedetomidine 0.6 μg /（kg.h） plus fentanyl 1 μg /（kg.h）.Both groups received the medicine at the time of entrance into the ICU after the operation.The clinical data including Ramsay sedation scale,heart rate（HR）,systolic pressure,diastolic pressure,respiration,pulse blood oxygen degree of saturation（SpO 2）,the duration of mechanical ventilation,and residence time in ICU were recorded before the medication and at five time points of 4,8,12,24 h after the medication.Results There was no significant difference in Ramsay sedation scale,systolic pressure,and diastolic pressure between the two groups（P 0.05）.After the medication,the HR of group D decreased compared with that of group M（P 0.05）.The duration of mechanical ventilation and the residence time in ICU of group D were significantly shorter than those of group M（P 0.05）.Compared with group M,group D had fewer incidence of respiratory inhibition effect（P 0.05）.Conclusion Dexmedetomidine combined with fentanyl can significantly reduce the duration of mechanical ventilation and the residence time in ICU and has no obvious inhibitive effect on spontaneously breathing.It is a relatively safe and effective treatment for postoperative sedation and analgesia for patients with coronary artery disease.