右美托咪啶对多发伤机械通气患者镇静镇痛的疗效分析

Sedation and analgesia effects of dexmedetomidine on multiple trauma patients with mechanical ventilation

目的观察右美托咪啶（DEX）对多发伤患者机械通气中的镇静镇痛效果。方法采用回顾性病例对照研究分析2016年9月～2017年3月收治的80例多发伤机械通气患者临床资料，其中男58例，女22例；年龄18～60岁，平均41．87岁。损伤严重度评分（ISS）（18．45±4．53）分。患者人科后予以镇静镇痛治疗，依据镇静药物不同分为两组，DEX组使用DEX复合酒石酸布托啡诺（40例），咪达唑仑组使用咪达唑仑复合酒石酸布托啡诺（40例）。比较两组镇静程度评分（Ramsay评分）、起始用药达到镇静镇痛满意时间、每日唤醒时间、机械通气时间、急诊重症监护病房（EICU）住院时间、酒石酸布托啡诺使用量、心率、血压变化及谵妄发生率。结果（1）两组均能达到目标镇静效果。DEX组每日唤醒时间、机械通气时间和EICU住院时间较咪达唑仑组短（P〈0．05）；（2）咪达唑仑组达镇静满意时间较DEX组短（P〈0．05）；（3）DEX组较咪达唑仑组酒石酸布托啡诺使用量少，谵妄发生率低（P〈0．05）；（4）DEX组与咪达唑仑组收缩压、舒张压及心率镇静前后组内比较，差异有统计学意义（P〈0．05），但两组间比较差异无统计学意义（P〉0．05）。结论DEX用于多发伤机械通气患者中可获得良好的镇静镇痛效果，能缩短每日唤醒时间、机械通气时间及EICU住院时间，可减少酒石酸布托啡诺用量，并能减少谵妄的发生率；镇静镇痛前后血压、心率变化幅度小，安全可靠。

Objective To explore the sedation arid analgesia effect of dexmedetomidine （DEX） in patients with multiple trauma during mechanical ventilation. Methods Eighty cases of multiple trauma patients under mechanical ventilation treated from September 2016 to March 2017 were analyzed by retrospective case-control study. There were 58 males and 22 females with an age range of 18-60 years （mean, 41.87 years）. The injury severity score （ISS） was （ 18.45 ± 4.53） points. The patients were treated with sedation and analgesia, and they were divided into two groups according to the sedative drugs. DEX composite tartaric acid butorphanol were used in 40 patients as DEX group. Midazolam composite tartaric acid butorphanol were used in 40 patients as Midazolam group. The degree of sedation score （ Ramsay score） were compared between groups. The time from initial drug use to effective sedation achievement, daily wake-up time, mechanical ventilation duration, emergency intensive care unit （EICU） time, dosage of tartaric acid butorphanol, heart rate, blood pressure changes, and incidence of delirium were compared. Results （ 1 ） Two groups could both reach the target of sedation. DEX group had shorter daily wake-up time, shorter mechanical ventilation time and shorter length of EICU stay compared with Midazolam group （ P 〈 0. 05 ）. （2） The time to achieve satisfied sedation after initial usage in Midazolam group was shorter than that in DEX group （ P 〈 0. 05 ）. （ 3 ） DEX group had smaller tartaric dosage of acid butorphanol, and lower incidence of delirium compared those in Midazolam group （ P 〈 0. 05 ）. （4） The comparison of systolic blood pressure, diastolic blood pressure, heart rate within either group showed significant difference before and after sedation （ P 〈 0. 05 ）, but had no significant difference between two groups （P 〉 0. 05）. Conclusions For multiple trauma patients with mechanical ventilation, DEX can attain sedation and analgesia and shorten daily wake-up time, mechanical ventilation time, and length of hospital stay. DEX can reduce the dosage of analgesic （butorphanol） and the incidence of delirium. Blood pressure and heart rate are associated with small variations before and after sedation.