右美托咪啶在慢性阻塞性肺疾病急性加重期患者脱机后镇静作用临床研究

Sedative effect of dexmedetomidine for patients with chronic obstructive pulmonary disease in acute exacerbation period after weaning from mechanical ventilation

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者脱机后应用右美托咪啶镇静的可行性及安全性。方法成功撤机〉12h的慢性阻塞性肺疾病急性加重期患者36例，给予右美托咪啶负荷剂量1．0μg／kg，维持剂量0．2-0．7μg（kg·h），保持患者Ramsay镇静深度评分3-4分，给药0min、30min、1h、3h、6h对患者收缩压、舒张压、心率、呼吸频率、脉搏氧饱和度、血气分析进行监测。结果患者在给药30min、1h、3h、6h时，心率、收缩压及舒张压下降（P〈0．05），PCO2无明显改变（P〉0．05），患者脱机后动脉血氧分压（PaO2）6h后显著地高于0min时（P〈0．05）。结论右美托咪啶用于重症监护室（Intensive Care Unit，ICU）AECOPD患者撤机后镇静未产生明显呼吸抑制，血压和心率轻度降低，二氧化碳无潴留。

Objective To investigate the feasibility and safety of dexmedetomidine for patients with chronic obstructive pulmonary disease in acute exacerbation period （AECOPD） after being weaned from mechanical ventilation. Methods 36 patients with AECOPD after being successfully weaned from mechanical ventilation over 12 hours were given dexmedetomidine in a loading dose 1.0 p.g/kg and a maintenance dose of 0.2-0.7 p.g/（kgoh）. The scores of the depth of Ramsay sedation in all the patients were kept within 3-4 points. 30 minutes and 1, 3, and 6 hours after drug administration, the systolic blood pressure, diastolic blood pressure, heart rate, breathing rate, pulse oxygen saturation, blood gas analysis were detected. Results 30 minutes and 1, 3, and 6 hours after drug administration, the heart rate and systolic and diastolic blood pressures markedly decreased （P 〈 0.05） and PCO2 didn＇t significantly changed （P 〉 0.05）. The arterial blood oxygen partial pressure （PaO2） was significantly higher 6 hours than 0 minute after being weaned from mechanical ventilation （P〈0.05）. Conclusions Dexraedetomidine for patients with AECOPD after being weaned from mechanical ventilation in ICU doesn＇t have significant respiratory depression and no carbon dioxide retention and slightly lowers blood pressure and heart rate.