不同镇静深度对严重多发伤患者血流动力学的影响

Effect of sedative level on the hemodynamics of severe multiple-injury patients

目的探讨不同镇静深度对严重多发伤患者血流动力学的影响。方法纳入我科2014年11月至2016年2月收治的严重多发伤患者60例,随机分为A组和B组,每组30例。在脉搏指示连续心排血量(Pi CCO)监测技术监测下,以不同剂量右美托咪啶使A组[初始剂量:1μg/(kg·h)]患者维持深度镇静,B组[初始剂量:0.5μg/(kg·h)]患者维持轻度镇静,之后均以0.2μg/(kg·h)剂量维持;两组静脉输注舒芬太尼镇痛剂量(5.0μg/kg)及方案一致。观察两组患者镇静、镇痛前(T0)及后6 h(T_1)、12 h(T_2)、24 h(T_3)、48 h(T_4)、72 h(T_5)的心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、氧合指数(PaO_2/FiO_2)、左心室收缩力指数(d Pmax),以及镇静、镇痛相关不良反应。结果两组患者HR在镇静、镇痛后均逐渐下降,其中B组患者T_2、T_3时间点的HR显著低于A组(P<0.05);两组患者CVP、PaO_2/FiO_2、d Pmax在镇静、静痛后逐渐上升,其中B组患者的CVP(除T_1)显著低于A组(P<0.05),PaO_2/FiO_2和d Pmax(除T_1)显著高于A组(P<0.05);A组患者的MAP在T_1、T_2、T_4、T_5时间点较T_0降低(P<0.05);B组患者的MAP在T_1较T_0降低(P<0.05),其他时间点与T0相比差异无统计学意义,其中B组患者在T_2、T_4、T_5时间点的MAP显著高于A组(P<0.05)。A组患者不良反应发生率(16.7%)高于B组(6.7%,P<0.05)。结论在严重多发伤患者的镇痛、镇静中,适当降低镇静深度,能避免严重多发伤患者血流动力学的剧烈波动,同时可减少镇静药物的用量及其相关不良反应。

Objective To investigate the effect of sedative level on the hemodynamics in severe multiple-injury patients. Methods A total of 60 patients with severe multiple-injury from November 2014 to February 2016 were randomly divided into group A [1 mg/（kg·h） dexmedetomidine] and group B[0.5 mg/（kg.h） dexmedetomidine]. Under the guidance of pulse indicator continuous cardiac output （PiCCO） monitoring technique, the patients in group A were given deep sedation by regulating dexmedetomidine dose, while group B were given mild sedation. The heart rate （HR）, central venous pressure （CVP）, mean arterial pressure （MAP）, PaOE/FiO2, and dPmax at before （To） and after sedation and analgesia 6 h（T1）, 12 h（T2）, 24 h（T3）, 48 h（T4）, 72 h（T5） in both groups were observed. Results After sedation, the HR in two groups were decreased gradually, the HR at T2 and T3 in group B was lower than those in group A （P〈0.05）. The CVP, PaO2/FiO2 and dPmax were increased gradually after sedation and analgesia, the CVP （except T1） in group B were lower than that in group A （P〈0.05）. The PaO2/FiO2 and dPmax （except T1） in group B were higher than those in group A （P〈0.05）, the MAP at Tl, T2, T4, T5 of group A were lower than those at To （P〈0.05）, the MAP in T1 of group B was lower than that in TO （P〈0.05）, and there was no significant difference between the other time points and T0. The MAP at Z2, T4 and T5 of group B were higher than those in group A （P〈0.05）. The adverse reaction rate in group A （16.7%） was higher than that in group B （6.7%, P〈0.05）. Conclusion To reduce the sedative depth in severe multiple-injury patients reasonably can help to avoid the volatility of hemodynamics and reduce the adverse reactions related to sedation.