右美托咪定在急性左心衰治疗应用中的疗效和安全性探讨

Efficacy and safety of dexmedetomidine in patients with acute left heart failure

目的:探讨右美托咪定在急性左心衰中应用的有效性和安全性。方法:48例急性左心衰患者随机分为常规治疗组(C组)、右美托咪定组(D组),分别在入ICU时、治疗24和48 h,采用床旁心脏超声测定两组患者的左心室射血分数(left ventricular ejection fraction,LVEF),左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD);测定两组患者的血浆B型利钠肽(B-type natriuretic peptide,BNP)水平,计算其变化率;监测动脉血气分析,计算氧合指数;观察两组患者在治疗48 h内心率、平均动脉压、气管插管机械通气情况,记录两组患者的吗啡使用量和使用次数。结果:入ICU时,两组患者在LVEF、LVEDD、BNP水平、氧合指数、心率、平均动脉压方面差异均无统计学意义,P>0.05;治疗24和48 h时D组LVEF均明显高于C组,LVEDD均明显低于C组,BNP变化率均高于C组,心率均明显低于C组,氧合指数均明显高于C组,差异有统计学意义,P<0.05;治疗48 h内,两组患者均未发生明显的心动过缓和难治性的低血压,D组气管插管率为20.8%,未明显高于C组(16.7%),差异无统计学意义,P>0.05;治疗48 h内D组吗啡的使用次数和使用总量分别为24次和100 mg,均低于C组的37次和188 mg,差异均有统计学意义,P<0.05。结论:右美托咪定在ICU严密的监测下可安全地用于急性左心衰患者的镇静。

Objective： To explore the efficacy and safety of dexmedetomidine in patients with acute left heart failure. Methods： 48 patients with acute left heart failure were randomly divided into conventional treatment group and dexmedetomidine group. At admission, 24 and 48 hours after ICU admission, the left ventricular ejection fraction（LVEF） and left ventricular diastolic internal diameter（LVEDD） were determined by bedside cardiac ultrasound, the level of plasma B-type natriuretic peptide（BNP） were measured along with the rate of its change. Arterial blood gas analysis was used to measure the arterial oxygen pressure, oxygenation index. Within 48 hours after treatment, physiologic data were collected including heart rate, mean arterial pressure, tracheal intubation and mechanical ventilationi, along with the amount and frequency of morphine infusion. Results： There were no significant differences between the two groups at the admission in LVEF, LVEDD, BNP levels, oxygenation index, heart rate and mean arterial pressure, P〈0.05. Compared with the routine treatment group at 24 and 48 hours after ICU admission, LVEF, the decrease rate of BNP and oxygenation index were higher in dexmedetomidine group, along with lower LVEDD and heart rate, P〈0.05. Within 48 hours after ICU admission,there were no significant diffterence bwteen the two groups in bradycardia and refractory hypotension. The tracheal intubation rate in dexmedetomidine group was 20.8%, at the similar level of that in conventional treatment group（16.7%）, P〈0.05, the amount and frequency of morphine infusion in dexmedetomidine group were 24 times and 100 mg, which were significantly lower than that in conventional treatment group（37 times and 188 mg）, P〈0.05. Conclusion： Dexmedetomidine can safely be used in patients with acute left heart failure under intensive monitoring in ICU.