右美托咪啶用于重症监护病房镇静的效果评价

目的观察右美托咪啶用于重症监护病房（ICU）镇静的效果及安全性。方法选择全身麻醉腹部手术后带气管插管转入ICU患者40例，随机分为右美托咪啶组（D组）和丙泊酚组（P组）各20例。D组予右美托咪啶负荷量1μg／kg20min内静脉泵入，每1h依据Ramsay评分调整药物泵入剂量为0．2～0．7μg／（kg·h）；P组予丙泊酚负荷剂量lmg／kg静脉注射，根据不同镇静程度维持剂量为O．5～3mg／（kg·h）。每2h进行数字疼痛评分（NRS），当NRS评分大于4分时给予芬太尼1μg／kg；达到拔管备件者拔出气管导管。结果与P组比较，D组镇静效率明显较高（P〈0．05），芬太尼用量明显减少（P〈0．05），停药后苏醒、拔管时间明显缩短（P〈0．05）；用药期间两组心血管事件发生率有显著性差异（P〈0．05），术后谵妄发生率无显著性差异（P〉0．05）。结论右美托咪啶用于ICU的镇静、镇痛效果好，苏醒快，可缩短拔管时间，血流动力学稳定，谵妄发生率低，是ICU理想的镇静剂。

Evaluation on Sedation Effect of Dexmedetomidine Used in ICU

Objective To observe the sedation efficacy and safety of dexmedetomidine used in ICU. Methods 40 patients with endotra- cheal intubation transferred to ICU after abdominal operation under general anesthesia,were randomly divided into the dexmedetomidine group （D,20 cases） and the propofol group （P,20 cases）.The group D was given the dexmedetomidine loading dose of 1 μg/kg by intravenous pumping within 20 rain,adjusting pumping dose to 0.2- 0.7 μg/（kg·h） per 1 h according to the Ramsay score;the group P was given the propofol loading dose of lmg/kg by intravenous injection,with the maintenance dose of 0.5-3 mg/（kg· h） depending on the degree of sedation. The digital pain score of the numeral rating scale（NRS） was performed once every 2 h,when the NRS score 〉 4, adding fentanyl 1 txg/kg; when reaching the conditions of endotracheal extubation, the tracheal catheter was re- moved. The sedation efficiency, fentanyl dosage, waking time, extubation time, duration of mechanical ventilation, incidence cardiovascular events and delirium were compared between the two groups. Results The sedation effect in the group D was significantly higher than that in the group P （P 〈 0. 05）;compared with the group P,the fentanyl dosage in the group D was significantly reduced（P 〈 0.05）, the recovery time and the extubation time after stopping medication were significantly shortened（P 〈 0. 05 ） ; during medication period, the incidence rate of cardiovascular events had significantly difference between the two groups （P 〈 0. 05）. The incidence rate of post- operative delirium had no statistical difference （P 〉 0.05）. Conclution Dexmedetomidine used in ICU has good sedative and anal- gesic effect, rapid recovery, shortened extubation time,low incidence rate of delirium and hemodynamic stability,which is an ideal seda- tion agent used in ICU.