右美托咪定、丙泊酚联合酒石酸布托啡诺对重症患者镇静镇痛效果及血流动力学的影响

Sedative,analgesic,and hemorhelogic effects of dexmedetomidine and propofol combined with butorphanol for severe patients

目的比较研究右美托咪定、丙泊酚联合酒石酸托啡诺对重症患者镇静镇痛效果及血流动力学的影响.方法选择2017年1月—2019年6月如皋市人民医院重症监护室(ICU)收治的重症患者88例为研究对象,根据镇静镇痛方式分为实验组例46例、对照组42例.对照组给予丙泊酚联合酒石酸布托啡诺镇静镇痛治疗,实验组给予右美托咪定联合酒石酸布托啡诺镇静镇痛治疗,比较两组镇静镇痛效果、血液流变学、不良反应等指标.结果实验组重症患者视觉模拟疼痛(VAS)评分低于对照组,镇静达标时间长于对照组,酒石酸布托啡诺用量少于对照组,ICU住院时间短于对照组[(2.87±0.54 vs 3.24±0.60)、(31.12±4.32 vs 28.65±4.24)min、(15.21±3.12 vs 19.45±3.34)mg、(3.52±0.56 vs 4.24±0.72)d](t=3.045,2.703,6.157,5.261,P<0.05);心率(HR)明显低于对照组,收缩压(SBP)、舒张压(DBP)明显高于对照组[(76.45±9.12 vs 92.12±10.24)n/min、(121.45±11.32 vs 102.32±14.12)mmHg、(62.34±7.12vs 54.23±7.36)mmHg](t=7.593,7.040,5.252,P<0.05);实验组重症患者谵妄等不良反应30.43%明显低于对照组52.38%(χ2=4.374,P<0.05).结论右美托咪定有助于缓解重症患者疼痛程度,维持血压相对稳定,缩短ICU住院时间,降低谵妄等不良反应发生率,但应预防心动过缓风险.

Objective To investigate the sedative,analgesic,and hemorhelogic effects of dexmedetomidine and propofol combined with butorphanol for severe patients.Methods 88 severe patients were randomLy selected and divided into 2 groups:control group(n=42)treated with propofol by intravenous pumping and butorphanol tartrate by intravenous injection based on the visual analogue score(VAS)to maintain the Ramsay sedation score al 2~4;and experimental group(n=46)given dexmedetomidine by intravenous pumping and butorphanol tartratle by intravenous injection according to the visual analogue score(VAS)to maintain the Ramsay sedation score at 2-4.Then the Ramasay sedation scores,time of reaching sedation standard,VAS score,total dosage of butorphanol tartrate,and hemorheologic markers.,such as heart rate(HR),systolic blood pressure(SBP),diastolci blood pressure(DBP),and oxygen saturation(SpO,)of these 2 groups were measured.The adverse reactions were recorded.Results There were no significant differences in the gender,age,disease profile,and APACHE I score between these 2 groups(all P>0.05).The VAS of the experimental group was(2.87±0.54),significantly lower than that of the control group[(3.24±.60)the time of reaching sedation standard of the experimental group was(3.24±0.60)min,significantly longer than that of the control group[(2.87±0.54)min];the lotal butorphanol dos-age of the experimental group was(15.21±3.12)mg.sgnificantly lower than that of the control group(19.45±3.34)mg);[and the ICU stay time of the experimental group was(3.52±0.56)d,,significanly longer than that of the control group(4.24±0.72)d](t=3.045.2.703,6.157,and 5.261,all P<0.05).The HR of the experimental group was(76.45±9.12)n/min,,significantly lower than that of the control group[(92.12±10.24)n/min],and the SBP and DBP levels of the experimental group were(121.45±11.32)mmHg and(62.34±7.12)mmHg respectively,both significantly higher than those of the control group[102.32±14.12mmHg and(54.23±7.36)mmHg rspectively1(=7.593.7.040.and 5.252.all P<0.05).The adverse reaction rate of the experimental group was 30.43%,significantly lower than that of the control group(52.38%,X^2=4.374,P<0.05).Conclusion Dexmedetomidine helpsrelieve the pain,keep the blood pressure relatively stable,shorten the ICU stay,reduces the adverse reaction rate:however,it is necessary to prevent the bradycardia risk.