ICU机械通气患者中右美托咪定与舒芬太尼的临床应用

Clinical application of dexmedetomidine and sufentanil in ICU patients with mechanical ventilation

目的 观察分析右美托咪定与舒芬太尼联合治疗ICU机械通气患者的临床效果。方法 选取2014年2月-2015年3月绍兴市立医院ICU行机械通气治疗的危重患者80例,随机均分为研究组和对照组（n=40）,研究组采用右美托咪定与舒芬太尼联合给药治疗,对照组采用舒芬太尼与咪达唑仑联合给药治疗,对比2组患者用药后不同时间点的镇静效果、镇痛效果。结果 用药后各时间点,研究组SAS评分与对照组相比差异无统计学意义;研究组呼吸顺应性、上肢、面部表情的BPS评分均低于对照组,差异有统计学意义（P〈0.05）;研究组不良反应发生率为7.5%（3/40）,显著低于对照组22.5%（9/40）,差异有统计学意义（P〈0.05）;治疗前2组MAP、SpO2、HR等指标对比差异无统计学意义;而治疗后2组各时间点以及拔管后的MAP、SpO2、HR等指标与治疗前对比差异有统计学意义（P〈0.05）,且研究组各时间点以及拔管后的MAP、SpO2、HR等指标与对照组相比差异有统计学意义（P〈0.05）。结论 采用右美托咪定与舒芬太尼联合对ICU机械通气患者镇静、镇痛效果良好,治疗确切,值得临床广泛实践。

Objective To observe and analyze the clinical effect of dexmedetomidine combined with sufentanil in the treatment of ICU mechanical ventilation. Methods 80 cases of critically ill patients treated by mechanical ventilation in our hospital ICU from February 2014 to March 2015 were randomly divided into study group and control group （n=40）, the study group was treated with dexmedetomidine and sufentanil combined drug treatment, the control group was treated with sufentanil and midazolam combined drug treatment. The sedative effect and analgesic effect of the two groups were compared at different time points after the administration. Results At each time point after medication, there was no significant difference with the score of SAS between study group and control group; The BPS scores of respiratory compliance, upper limb and facial expression of the study group were lower than those of the control group, the difference was statistically significant; the incidence of adverse reaction in the study group was 7.5% （3/40）, which was significantly lower than that of the control group 22.5% （9/40）, the difference was statistically significant （P〈0.05）; There were no significant differences in MAP, SpO2 and HR between the two groups before treatment; After treatment, the indexes of MAP, SpO2 and HR in the two groups at different time points and after extubation were significantly different from those before treatment （P〈0.05）, The difference of MAP, SpO2 and HR between the two groups at each time point after treatment and after extubation were statistically significant （P〈0.05）. Conclusion The combination of dexmedetomidine and sufentanil for ICU mechanical ventilation has a good sedative and analgesic effect, and is worthy of clinical practice, and it is worthy of clinical practice.