右美托嘧啶在ICU高血压脑出血术后患者中的临床应用效果

Dexmedetomidine in post—operation patients with hypertensive cerebral hemorrhage in ICU

目的:观察右美托嘧啶在ICU高血压脑出血术后患者中的临床应用效果。方法:选择2015-07~12我院急诊ICU收治的高血压脑出血术后患者96例,排除存在其他脏器功能障碍且GCS评分>8分的患者,随机分为右美托嘧啶组和咪达唑仑组,每组48例。两组患者均先给予芬太尼5μg/(kg·h)持续泵入,然后右美托嘧啶组给予右美托嘧啶负荷剂量1μg/kg,静脉推注时间>10min,泵入剂量为0.2~0.7μg/(kg·h);咪达唑仑组给予咪达唑仑负荷剂量0.05mg/kg,泵入剂量为0.03~0.20mg/(kg·h)。患者镇静程度以RASS镇静和躁动评分评估,目标值在-2~0分。每隔3h根据镇静评分调整镇静药物剂量,观察镇静期间两组患者的生命体征变化及停药后清醒时间、谵妄发生率、ICU住院时间、28d转归等指标差异。结果:两组患者的年龄、性别、GCS评分、APACHEⅡ评分等均无统计学差异。镇静期间右美托嘧啶组的血压和心率均低于咪达唑仑组,需要使用乌拉地尔控制血压的例数(n=16)少于咪达唑仑组(n=24),发生谵妄的例数(n=7)也少于咪达唑仑组(n=16),均P<0.05。两组的ICU住院时间、28d转归均无统计学差异。结论:右美托嘧啶对ICU高血压脑出血术后患者有良好的镇静效果,而且有稳定患者血流动力学、抗谵妄等优势。

Objective： To observe the clinical application effect of dexmedetomidine in post--operation patients with hypertensive cerebral hemorrhage in intensive care unit （ICU）. Methods： Ninety- six post- operation patients with hypertensive cerebral hemorrhage in EICU, excluding other organ dysfunction and GCS score greater than 8, were included in this study.The patients were randomly divided into dexmedetomidine group and midazolam group, 48 cases in each group.All patients were given fentanyl 5 μg/（kg · h） continuously firstly.And then the dexmedetomidine group were given dexmedetomidine with a bolus dose of 1 μg/kg intravenously over 10 minutes,and received a continuous dexmedetomidine infusion at 0.2-0.7μg/（kg· h）.The midazolam group were given midazolam with a bolus dose of 0.05 mg/kg intravenously, and received a continuous midazolam infusion at 0.03-0.20 mg/（kg · h）. Sedation level of the patients was evaluated by richmond agitation--sedation scale （RASS） with targeted value -2 to 0.The dose of sedation drugs were adjusted according to RASS every three hours.Changes of vital sign and recovery time after treatment, the incidence of delirium, ICU length of stay, 28 days outcomes were recorded. Results： There were no significant differences in age, sex, GCS score, APACHE 1I score between the two groups. The blood pressure and heart rate of the dexmedetomidine group patients were lower than those of the midazolam group. Patients using urapidil to control blood pressure in the dexmedetomidine group （n = 16） were less than that of the midazolam group （n = 24）, and the delirium rate （n=7） was significantly lower in the midazolam group （n = 16）, P 〈0.05. There was no statistical differences in ICU length of stay and 28 days outcomes between two groups. Conclusion： Dexmedetomidine has a good sedative effect on ICU hypertensive cerebral hemorrhage,and also has more stable hemodynamics, reduced delirium and other advantages.