右美托咪定和丙泊酚用于神经外科躁动患者镇静的比较研 究简

目的 评价神经外科躁动患者应用右美托咪定和丙泊酚镇静治疗的效果及不良反应.方法 选择2010年3月～2011年3月入住武汉大学人民医院ICU中的神经外科急重症及术后躁动患者60例,随机分为两组,右美托咪定组（D组）和丙泊白酚组（P组）,监测给药前（T1）及给药后10 min（T2）、1 h（T3）、2 h（T4）、6 h（T5）和次日清晨7：00（T6）的平均动脉压、心率、呼吸频率、脉搏血氧饱和度,记录药物起效时间、达到Ramsay镇静评分2～4级时药物平均输注速度.结果 两组药物起效时间比较差异有高度统计学意义（P＜0.01）,D组患者用药后血压及心率均有所下降（P＜0.05）,用药后呼吸频率与T1相比虽有所下降,但差异无统计学意义（P＞0.05）;P组镇静治疗后血压较给药前下降,差异有统计学意义（P＜0.05）,与T1比较,T2～4的心率明显下降（P＜0.05）,用药后10 min内即观察到呼吸频率下降,T2与T1相比差异有统计学意义（P＜0.05）.结论 右美托咪定和丙泊酚微量泵持续输入用于神经外科躁动患者镇静安全有效,丙泊酚可应用于躁动患者的快速镇静,右美托咪定镇静过程中无明显呼吸抑制发生,但要注意防范血压下降和心率减慢的不良反应.

Comparative study of sedation between Dexmedetomidine and Propofol in neurosurgical patients from restlessness

Objective To evaluate the sedation and adverse effects of Dexmedetomidine and Propofol in the treatment of neurosurgically restless patients.Methods 60 neurosurgically restless patients of acute critical or after the operation who were hospitalized to the intensive care unit （ICU） of People＇s Hospital of Wuhan University from March 2010 to March 2011.They were randomly divided into two groups,namely Dexmedetomidine group and Propofol group （group D and group P）.The mean arterial blood pressure （MAP）,heart rate （HR）,respiration rate （RR）,pulse oxygen saturation （SpO2） and before administration （T1） and 10 min （T2）,1 h （T3）,2 h （T4）,6 h （T5）,（T6） after continuous infusion were recorded.Drug onset time,average drug infusion rate to Ramsay 2-4 were monitored.Results Significant difference was found in the onset time of two groups （P 〈 0.01）.In Dexmedetomidine group,blood pressure and heart rate were decreased after treatment （P 〈 0.05）,respiratory rate decreased between T1 and after using the drugs at different time points,but it showed no significant difference （P 〉 0.05）.In group P,mean arterial blood pressure decreased significantly comparing with T1 （P 〈 0.05） at T2-6,comparing with T1,the heart rate in T2-4 reduced significantly （P 〈 0.05）,the respiratory rate in T2 reduced comparing with T1 after injected a loading dosage in 10 minutes,which showed significant difference （P 〈 0.05）.Conclusion Dexmedetomidine and Propofol infused continuously with pump thereafter is safe to neurosurgically restlessly patients.The patients with agitation who needed to compose in a quick way should prefer Propofol.During the process of Dexmedetomidine composing,there is no significant respiratory depresstion,but need pay attention to adverse reactions to prevent hypotension and bradycardia.