ICU患者应用右美托咪啶抗焦虑作用的临床观察

Clinical observation of anxiolytic effect of dexmedetomidine on patients in intensive care unit

目的观察右美托咪啶镇静对重症监护室(ICU)清醒患者的抗焦虑作用。方法本院ICU收治的64例清醒患者按照随机数字表法分为右美托咪啶组(35例)和咪达唑仑组(29例)。右美托咪啶组经静脉泵入负荷剂量的右美托咪啶1μg/kg、10 min,继以0.2～0.7μg/(kg·h)维持;咪达唑仑组给予负荷剂量咪达唑仑0.06 mg/kg,再以0.04～0.20 mg/(kg·h)维持。两组患者均常规给予芬太尼注射液持续静脉泵入镇痛。根据Prince-Henry评分调节芬太尼剂量,使疼痛评分维持在1～2分;根据Ramsay评分法调整镇静药剂量,使镇静深度评分控制在2～3分。比较两组患者在用药前后不愉快情绪体验(VAS-U)、芬太尼用量、谵妄发生率、自主呼吸频率、血压和心率等变化。结果右美托咪啶与咪达唑仑均能使患者达到目标镇静、镇痛评分,两组患者用药后VAS-U评分均较用药前降低,但两组之间用药后VAS-U评分差异无统计学意义(P>0.05);与咪达唑仑组比较,右美托咪啶组芬太尼用量明显减少(P<0.05);谵妄发生率明显降低(P<0.05)。右美托咪啶组有2例出现心率减慢,1例出现血压下降,自主呼吸频率无明显变化;咪达唑仑组有2例出现血压下降,5例出现自主呼吸频率减慢。结论使用右美托咪啶镇静对入住ICU的清醒患者有抗焦虑作用,可减轻患者疼痛、降低谵妄发生率、减轻患者不良情绪体验。

Objective To observe the anxiolytic effect of dexmedetomidine on sober patients in intensive care unit. Methods Sixty-four sober patients admitted to intensive care unit（ICU） were randomly divided into dexmedetomidine group（ n = 35）and mid- azolam group（ n = 29 ）. Patients in the dexmedetomidine group were given a loading dose（ 1 Ixg/kg）for 10 minutes and then maintained with 0. 2 -0. 7 μg/（kg · h）. Patients in the midazolam group were given a loading dose（0. 06 mg/kg） and then maintained with 0. 04 - 0. 20 rag/（ kg · h）. Intravenous fentanyl was continually given for analgesia in the both groups. The dose of fentanyl was adjusted ac-cording to Prince-Henry analgesic score to keep at 1 - 2 analgesic score. The dose of sedation was regulated according to Ramsay scores to maintain at 2 - 3 sedative scores. The unpleasant experiences of negative emotions （VAS-U） before and after the sedation, dose of fen-tanyl, incidence of delirium, respiratory rate, and changes in blood pressure （BP）and heart rate （HR）were compared between the two groups. Results All patients in the two groups obtained the expected sedative and analgesia scores. The VAS-U was significantly lower after taking dexmedetomidine or midazolam than before, but there was no significant difference in VAS-U between the two groups. Compared with the midazolam group, dose of fentanyl was significantly smal- ler in the dexmedetomidine group than that in the midazolam group（P 〈 0. 01 ）, and incidence of delirium in the patients treated with dexmedetomidine was significantly lower than that in the patients treated with midazolam（ P 〈 0. 01 ）. The HR was reduced in two cases and BP was dropped in one case with no significant change in respiratory rate in the dexmedetomidine group,while the BP was dropped in two cases with significantly reduced respiratory rate in five patients in the midazolam group（P 〈 0. 05）. Conclusion Dexmedetomi- dine has an anxiolytic effect on sober patients in ICU. The anxiolytic drug can relieve pains in patients with low delirium incidence and reduce the VAS-U.