右美托咪定在脑出血术后患者的镇静效果及安全性评价

Sedation and safety evaluation of dexmedetomidine in the postoperative patients of brain hemorrhage

目的评价右美托咪定结合Riker镇静躁动评分在脑出血术后患者的镇静效果及安全性。方法 70例脑出血术后患者,分为对照组和试验组各35例。对照组静脉输注咪达唑仑0.06 mg·kg^(-1),注药时间1 min,按0.05 mg·kg^(-1)·h^(-1)微泵持续泵入维持48 h;试验组则静脉泵注右美托咪定0.8μg·kg^(-1),维持剂量0.4μg·kg^(-1)·h^(-1)。若镇静过程中出现镇静过浅或躁动,给予芬太尼0.05~0.10 mg。记录用药后1,6,12,24,48 h的Riker镇静躁动评分,观察患者镇静用药前、用药后1,6,12,24,48 h的躁动情况和心率、平均动脉压及脉搏血氧饱和度、停药后苏醒时间、使用芬太尼的次数及用量、不良反应发生情况。结果与对照组比较,试验组在用药后各时点达到镇静的比例升高,而在用药后6,12,24,48 h的平均动脉压及心率降低,但均在临床正常值范围内。停药后的苏醒时间缩短,补给芬太尼的次数及躁动、恶心呕吐的病例少(P<0.05)。2组患者均无呼吸抑制发生。结论右美托咪定结合Risker镇静躁动评分可安全用于脑出血术后患者的镇静。

Objective To study the sedation and safety evaluation of dexmedetomidine combined with Riker sedation agitation score in the postoperative patients of brain hemorrhage. Methods Seventy patients were randomly divided into treatment group（ n = 35） and control group（ n = 35）. Patients in control group were injected with midazolam 0. 06mg·kg^（-1）,then 0. 05 mg·kg^（-1）·h^（-1）maintained for 48 h. Patients in treatment group were injected with dexmedetomidine 0. 8 μg·kg^（-1）,then0. 4 μg· kg^（-1）·h^（-1）maintained for 48 h. If sedation was not enough,0. 05-0. 10 mg fentanyl was injected. Recorded the Riker sedation agitation score of 1,6,12,24,48 h after sedation,the vital signs at before and 1,6,12,24,48 h after sedation,revive time,time of using fentanyl and side effect. Results Compared with control group,the ratio of the scores of Riker sedation agitation≤4 in treatment group had a significant rise,mean arterial pressure（ MAP） and heart rate（ HR） declined at time points after sedation,but they were all at the clinical normal ranges. Revive time after drug withdrawral shorted,times of using fentanyl declined,and the cases of agitation,nausea and vomiting all decreased（ P〈0. 05）. All patients had no respiratory depression. Conclusion Dexmedetomidinecombined with Riker sedation agitation score was safe and suited for the sedation in the postoperative patients of brain hemorrhage.