右美托咪定对悬雍垂腭咽成形术后机械通气镇静的作用

Efficacy of dexmedetomidine on mechanical ventilation after uvulopalatopharyngoplasty

目的：比较右美托咪定与咪达唑仑用于阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者行悬雍垂腭咽成形术（UPPP）术后的镇静效果。方法：选择择期行UPPP术的OSAHS患者64例，随机分为右美托咪定组（D组，n=32）和咪达唑仑组（M组，n=32）。术毕入重症监护室行机械通气，2组分别输注右美托咪定和咪达唑仑，使Ramsay评分维持于3～4分，复合舒芬太尼镇痛。如出现高血压或心动过速，予额外药物处理。并于入室2 h（T1）、10 h（T2）、20 h（T3）、拔管前即刻（T4）等时点监测患者应激激素水平。患者入室20 h停镇静药，拔管后待Aldrete评分达10分返回病房。结果：63例达预期镇静，D组24例不需额外药物调整血压或心率，M组8例，差异有统计学意义（P＜0.05）。各时点平均应激激素水平D组均低于M组，且各时点血压和心率均低于M组（P＜0.05）。D组停药至出重症监护室时间更短，且患者对镇静满意度评分更高（P＜0.05）。结论：对于行UPPP术的OSAHS患者，术后于重症监护室机械通气时使用右美托咪定镇静比咪达唑仑更具有优势。

Objective：To compare the effect of sedation between dexmedetomidine and midazolam for se-vere obstructive sleep apnea hypopnea syndrome （OSAHS） after uvulopalatopharyngoplasty （UPPP）. Methods：Sixty-four ASA Ⅰ-Ⅱ patients of severe OSAHS scheduled for UPPP were randomly allocated into group D （dex-medetomidine, n=32） and group M （midazolam, n=32）. The patients of the two groups were sedated with dexme-detomidine or midazolam respectively in the ICU after surgery and Ramsay scores of 3-4 were maintained. Suf-entanil were added for analgesia. The supposed hypertension or tachycardia were treated with extra medication. The administration of sedative was stopped after 20 hours stay in ICU and the patients were sent back to ward when the Aldrete score reached 10. Results：The anticipated depth of sedation were acquired in 63 patients and there was a signiifcant difference （P〈0.05） demonstrated by 24 patients in group D while 8 patients in group M received no extra medication for hypertension or tachycardia. The level of stress hormone, the mean arterial pres-sure and heart rate were signiifcantly lower in group D than group M at 2 h （T1）, 10 h （T2）, 20 h （T3） after entering ICU and before extubation （T4） respectively. The time intervals between medication suspend and departure from ICU were signiifcantly shorter while the degree of satisfaction for the process of sedation were higher in group D than that in group M. Conclusion：Dexmedetomidine has better features of sedation than midazolam for the pa-tients of severe OSAHS with mechanical ventilation after UPPP in ICU.