右美托嘧啶对ICU患者气管插管应激性反应和循环的影响

Analysis of the effects of dexmedetomidine on stress responses and circulation of ICU patients with trachea cannula treatment

目的:观察右美托嘧啶对ICU患者气管插管应激性反应和循环影响,探讨其临床价值。方法:选取60例本科室收治的重症患者入选本研究,按照配对分组发分为两组,每组30例,60例患者均于气管插管前开通静脉通道及行桡动脉穿刺监测有创动脉压,观察组泵注0.5μg/kg右美托嘧啶,时间10min,然后静注适量丙泊酚及顺-阿曲库铵;对照组泵注等量生理盐水后静注适量丙泊酚及顺-阿曲库铵,面罩给氧后行气管内导管插管,记录两组不同时刻血流动力学相关指标变化,并抽取动脉血测定皮质醇水平进行统计学分析。结果:两组丙泊酚、顺-阿曲库铵使用剂量比较,差异均无统计学意义(P>0.05);观察组气管插管即刻及气管插管5min后MAP及HR水平均低于对照组,血流动力学更为平稳,差异具有统计学意义(P<0.05);观察组右美托嘧啶泵注后、气管插管即刻及气管插管5min时刻皮质醇水平均低于对照组,差异具有统计学意义(P<0.05)。结论:右美托嘧啶应用于ICU患者气管插管可抑制应激性反应,且对循环影响较小,血流动力学较为平稳,具有重要临床价值。

Objective:To observe the effects of dexmedetomidine on stress responses and circulation of ICU patients with trachea cannula treatment and to discuss its clinical values.Methods:A total of 60 cases who were admitted in our hospital were randomly divided into study group and control group(n=30).Intravenous line of 60 cases was opened before trachea cannula treatment and radial artery puncture was performed for monitoring the invasive artery blood pressure.Patients in study group were given dexmedetomidine treatment for 10 minutes,with pump injection of 0.5μg·kg-1;then patients in study group were given the right dosage of propofol and cis-atracurium treatment,with intravenous injection;while patients in control group were given the equivalent normal saline(NS)treatment with pump injection and then were given the right dosage of propofol and cis-atracurium treatment.After mask oxygen inhalation,trachea cannula treatment was performed.Haemodynamics relevant index changes of both groups at different time were recorded and arterial blood was collected for determining the cortisol levels for statistical analysis.Results:The used dosage of propofol and cis-atracurium in both groups showed no obvious statistical significance.MAP and HR levels of patients in study group were lower than that in control group,and haemodynamics levels were more stable(P<0.05).Cortisol levels of patients in study group were(33.4±1.5)、(34.1±1.8)、(34.5±1.6)respectively after pump injection of dexmedetomidine,immediately after trachea cannula treatment and 5min after trachea cannula treatment were lower than that in control group and the difference was statistical significant(P<0.05).Conclusion:The clinical application of dexmedetomidine in trachea cannula treatment of ICU patients could inhibit the stress responses and had smaller effects on circulation,and its haemodynamics was relatively stable,which had important clinical values.