ICU围术期机械通气患者应用右美托咪定镇静效果观察

Observation of sedative effect of Dexmedetomidine on mechanical ventilation patients in ICU during perioperative period

目的观察右美托咪定对重症加强护理病房(ICU)围术期机械通气患者的镇静效果。方法 65例ICU围术期机械通气患者,按照随机数字表法分为对照组(31例)和试验组(34例)。试验组患者给予右美托咪定,对照组患者给予咪达唑仑。比较两组患者用药前、用药后10 min、6 h、12 h、撤机前1 h、撤机时及撤机后10 min的Ramsay评分、心率、平均动脉压及自主呼吸情况,并比较两组镇静前、镇静6、12 h的Riker镇静-躁动(SAS)评分。结果两组患者用药前、用药后10 min、撤机后10 min的Ramsay评分比较,差异无统计学意义(P>0.05);试验组患者用药后6、12 h的Ramsay评分低于对照组,撤机前1 h、撤机时Ramsay评分高于对照组,差异具有统计学意义(t=9.83、7.17、14.31、18.33, P<0.05)。镇静前、镇静6 h,两组患者SAS比较,差异无统计学意义(P>0.05);镇静12 h,试验组患者SAS评分低于对照组,差异具有统计学意义(P<0.05)。两组患者用药后10 min、6、12 h、撤机前1 h自主呼吸频率比较,差异有统计学意义(P<0.05);两组患者撤机前1 h、撤机时心率、自主呼吸频率、平均动脉压比较,差异有统计学意义(P<0.05)。结论右美托咪定在围术期机械通气患者镇静治疗方面效果良好,对呼吸和循环的影响小。

Objective To observe the sedative effect of Dexmedetomidine on mechanical ventilation patients in intensive care unit(ICU)during perioperative period.Methods A total of 65 patients with mechanical ventilation during perioperative period were divided into control group for 31 cases and experimental group for 34 cases according to the random number table method.Patients in the experimental group were given Dexmedetomidine,patients in the control group were given Midazolam.The Ramsay score,heart rate,mean arterial pressure and spontaneous breathing before medication,10 min,6 h and 12 h after medication,1 h before withdrawal,at withdrawal and 10 min after withdrawal between the two groups were compared.And the Riker sedation agitation scale(SAS)before sedation,6 h and 12 h after sedation between the two groups were compared.Results There were no significant differences in the Ramsay score between the two groups before medication,10 min after medication and 10 min after withdrawal(P>0.05).The Ramsay scores of the experimental group at 6 h and 12 h after medication were significantly lower than those of the control group,and the Ramsay scores of the experimental group 1 h before withdrawal and at withdrawal were significantly higher than those of the control group,the differences were statistically significant(t=9.83,7.17,14.31,18.33,P<0.05).And there were no significant differences in the SAS score before sedation and 6 h after sedation between the two groups(P>0.05).The SAS score of the experimental group after 12 h of sedation was significantly lower than that of the control group,the difference was statistically significant(P<0.05).There were significant differences in the spontaneous breathing frequency between the two groups after 10 min,6 h,12 h of medication and 1 h before weaning(P<0.05);there were significant differences in the heart rate,spontaneous breathing frequency and mean arterial pressure between the two groups at 1 h before weaning and at weaning(P<0.05).Conclusion Dexmedetomidine has a good sedative effect on mechanical ventilation patients during perioperative period,but has little effect on respiration and circulation.