右美托咪定复合酒石酸布托啡诺用于ICU机械通气患者镇痛镇静的病例对照研究

Case Control Study on Clinical Effect of Dexmedetomidine Combined with Butorphanol Tartrate on Sedation of Mechanically Ventilated ICU Patients

目的探讨右美托咪定用于ICU机械通气患者镇痛镇静的临床疗效。方法选择2011-01-2014-05间在我科使用右美托咪定和咪达唑仑复合酒石酸布托啡诺镇静镇痛治疗机械通气的40例患者,右美托咪定组20例,给予右美托咪定复合酒石酸布托啡诺镇静镇痛治疗;咪达唑仑组20例,给予咪达唑仑复合酒石酸布托啡诺镇静镇痛治疗;维持Ramsay镇静评分3-4分,记录两组患者布托啡诺用量、达到目标镇静所需的时间、停药后唤醒时间、谵妄发生率,以及两组患者用药前（T0）,用药后1 h（T1）,用药后6 h（T6）,用药后12 h（T12）的血氧饱和度、心率、收缩压、舒张压、呼吸频率等数值。结果右美托咪定组布托啡诺用量、达到目标镇静所需的时间、停药后唤醒时间、谵妄发生率均低于咪达唑仑组,差异有统计学意义（P〈0.05）;与T0比较,两组不同时间点心率、收缩压、舒张压、呼吸频率均降低,差异有统计学意义（P〈0.05）,两组血氧饱和度变化不大（P〉0.05）;用药后各时间点两组间比较,右美托咪定组心率、收缩压,舒张压降低幅度小于咪达唑仑组（P〈0.05）,两组间血氧饱和度和呼吸频率无显著差异（P〉0.05）。结论右美托咪定用于ICU机械通气患者镇静起效快,易唤醒,具有一定镇痛作用,可减少布托啡诺用量,镇静过程中血流动力学稳定,呼吸抑制作用轻微,谵妄等不良反应发生率低。

Objective To analyze clinical effects of dexmedetomidine combined with Butorphanol tartrate on sedation of mechanically ventilated ICU patients. Methods 40 patients from January,2010 to December,2013 using dexmedetomidine and midazolam combined with Butorphanol tartrate for sedation and analgesia were reviewed. All the patients were divided into two groups： dexmedetomidine group and midazolam group. There were 20 patients in the dexmedetomidine group,using dexmedetomidine combined with Butorphanol tartrate for sedation and analgesia. And there were 20 patients in midazolam group. The Ramsay score maintained 3 - 4,dosage of Butorphanol,the time required to achieve the desired sedation,recovery time after treatment,incidence of delirium were recorded. The HR,SBP,DBP,RR and SPO2 at pre- administration（ T0）,1 hour after administration（ T1）,6 hour after administration（ T6） and 12 hour after administration（ T12） were recorded. Results The dosage of Butorphanol,the time required to achieve the desired sedation,recovery time after treatment,incidence of delirium of dexmedetomidine group were lower than those of midazolam group; compared with T0,two groups had a decrease in HR,SBP,DBP,RR and had no change in SPO2 after administration. HR,SBP and DBP of dexmedetomidine group decreased less than those of midazolam group and there were no difference in RR and SPO2 of two groups in different times after administration. Conclusion There are some characters including rapid onset,easy to wake up and low incidence of delirium. The amount of Butorphanol can be reduced with stable hemodynamics,small influence on breathing and circulatory system,and low occurence rate of delirium.