小剂量右美托咪定滴鼻用于中心静脉穿刺术的效果评价

Application of small dose of dexmedetomidine nasal drops in bedside central venous puncture

目的探讨小剂量右美托咪定滴鼻用于中心静脉穿刺术的临床效果及安全性。方法将60例床旁中心静脉穿刺术患者随机分为观察组和对照组,每组各30例。观察组患者操作前经鼻滴入0.5μg/kg右美托咪定,双侧平均滴入,对照组患者经鼻滴入安慰剂-生理盐水,滴鼻操作均在操作前15分钟进行。记录并比较两组患者术中Ramsay镇静评分,术后视觉模拟评分法(VAS)评分、Mc Gill评分、不良反应发生情况及术前、术后简易精神状态检查量表(MMSE)评分。结果观察组患者Ramsay镇静评分明显高于对照组,VAS、Mc Gill评分均明显低于对照组,差异均有显著性(P<0.05)。观察组患者不良反应发生率为13.33%(4/30),对照组为6.67%(2/30),两组比较差异无显著性(P>0.05)。两组患者术前、术后MMSE评分组间、组内比较差异均无显著性(P>0.05)。结论小剂量右美托咪定滴鼻用于中心静脉穿刺术,可发挥轻微镇静及镇痛作用,对穿刺操作造成的不适感患者满意度好,无呼吸抑制的不良反应发生,安全可靠,值得推广应用。

Objective To investigate the effect of small dose of dexmedetomidine nasal drops central venous puncture in clinical efifcacy and safety. Method 60 cases of bedside in patients with central venous puncture were randomly divided into observation group and control group, 30 cases in each group. Observation group patients before operation by nasal instillation of 0.5μg/kg dexmedetomidine, bilateral average drops, control group were treated by nasal instillation of placebo saline nose drops, operations were performed in 15 minutes prior to the start of operation. Recorded and compared between the two groups of patients with Ramsay sedation scores, visual analogue scale （VAS） after the operation of mini mental state examination scores, McGill scores, the occurrence of adverse reactions and preoperative, postoperative （MMSE） scores. Result Ramsay sedation scores in observation group significantly higher than control group, VAS, McGill scores were significantly lower than control group, the difference was signiifcant （P0.05）. The two groups of patients before and after operation, MMSE scores between groups, within group comparisons showed no signiifcant difference （P〉0.05）. Conclusion Small dose dexmedetomidine intranasal for bedside central venous puncture, can play a mild sedative and analgesic action, brought to the puncture operation discomfort of patient satisfaction is good, without the occurrence of adverse reactions of respiratory inhibition, safe and reliable, worthy of popularization and application.