右美托咪啶对行纤维支气管镜检查的重症患者心脏功能的影响

Effect of dexmedetomidine on cardiac function of critically ill patients during fiberoptic bronchoscopy

目的:观察右美托咪定对重症患者行纤维支气管镜(纤支镜)检查时心率、平均动脉压和心电图的影响。方法:选择2013年5月—2014年5月住入ICU需要行纤支镜检查的患者50例,随机分成右美托咪啶组和对照组。右美托咪啶组在行纤支镜检查前15min给予2%利多卡因10ml雾化吸入,并静脉泵入右美托咪啶负荷量1μg/kg,10min匀速泵入,随后以0.2~0.4μg·kg-1·h-1的速度持续泵入,达到镇静程度为Ramsay评分4级,直至纤支镜检查结束。对照组仅行2%利多卡因10ml雾化吸入。观察两组患者检查开始前和检查结束时的心率、平均动脉压以及心电图ST-T段变化。结果:与纤支镜检查前比较,对照组患者在纤支镜检查结束时心率明显加快、平均动脉压明显升高,且与右美托咪啶组检查结束时比较差异有显著性(P<0.05)。右美托咪啶组纤支镜检查后心率、血压轻度升高,但与检查前比较差异无显著性(P>0.05)。右美托咪啶组ST-T下移或抬高大于0.05mV的患者仅5例,而对照组为15例,两组比较差异有统计学意义(P<0.05)。结论:危重患者在行纤支镜检查时给予右美托咪啶适当镇静可以稳定患者的循环系统,保护心肌。

Objective:To observe the effect of dexmedetomidine on heart rate,mean arterial pressure and electro-cardiogram (ECG)in critically ill patients during fiberoptic bronchoscopy. Methods:Fifty patients,admitted to ICU from May 2013 to May 2014 and undergoing fiberoptic bronchoscopy,were randomly divided into two groups:control group(n=25)and dexmedetomidine group (n=25). In patients of dexmedetomidine group,aero-sol inhalation of 2% idocaine 10 ml was given 15 minutes before bronchoscopy,and a loading dose of dexmedeto-midine 1μg/kg was injected intravenously within 10 minutes before bronchoscopy,followed by intravenous infu-sion of 0.2-0.4μg·kg-1 ·h-1 until the end of bronchoscopy. In the control group,patients only received aero-sol inhalation of 2% idocaine 10 ml. The heart rate,mean arterial pressure and changes in ST-T of ECG before and after bronchoscopy were observed.Results:In patients of the control group,a significant increase in heart rate and mean arterial pressure were observed(P<0.05),while in the dexmedetomidine group,the patient’s heart rate and mean arterial pressure increased only slightly after bronchoscopy(P>0.05),and the difference was not signif-icant compared to those before bronchoscopy(P>0.05). Changes in ST-T of ECG was higher than 5 mV in 5 ca-ses of the dexmedetomidine group,but it was observed in 1 5 cases in the control group,the difference was signifi-cant(P<0.05). Conclusions:For critically ill patients with bronchoscopy,administration of dexmedetomidine can stabilize the patient''s circulatory system and protect myocardium against stress.