右美托咪定致谵妄

Delirium induced by dexmedetomidine

1例81岁男性双足蓝趾综合征患者因左足趾剧烈疼痛,予右美托咪定0.2 mg入0.9%氯化钠注射液48 ml,以4 ml/h速度静脉泵入、1次/d。第3次静脉泵入右美托咪定约6 h时患者出现烦躁、谵妄;第5天因疼痛减轻,停用右美托咪定,停药后患者偶有谵妄。因入睡困难,停药第3天再次给予相同剂量右美托咪定。次日给予相同剂量右美托咪定2次,每次都在给药2~3 h出现明显的谵妄和烦躁。怀疑谵妄与右美托咪定有关,再次停用右美托咪定,换用曲马多和咪达唑仑治疗。停药第6天,患者意识转清,此后未再出现谵妄。

An 81‑year‑old male patient with bipedal blue toe syndrome received IV pumping of dexmedetomidine 0.2 mg dissolved in 0.9%sodium chloride injection 48 ml at the rate of 4 ml/h once daily because of severe pain in his left toe.The patient developed irritability and delirium about 6 hours after the 3rd IV pumping.The next day,the pain was relieved and dexmedetomidine was stopped.After drug withdrawal,the patient occasionally had delirium.Due to difficulty in falling asleep,the same dose of dexmedetomidine was given again on the 3rd day of drug withdrawal.The same dose of dexmedetomidine was given twice the next day and obvious delirium and irritability occurred 2‑3 hours after drug administration of each time.Delirium was suspected to be related to dexmedetomidine.Dexmedetomidine was stopped again and replaced by tramadol and midazolam.On the 6th day of drug withdrawal,the patient′s consciousness turned clear,and no delirium recured.