不同镇静药对口腔颌面外科术后留置气管导管患者的镇静作用

目的: 探讨不同镇静药对口腔颌面外科术后留置经鼻腔气管导管患者的镇静作用及其可能的不良反应。方法: 将60例口腔颌面外科术后留置经鼻腔气管导管患者按随机数字表法为3组,每组20例。患者入ICU后,各组患者均采用氢吗啡酮镇痛,分别采用咪达唑仑、丙泊酚和右美托咪定镇静,分别记录入ICU镇静前(T₀)和镇静开始后30 min(T₁)、1 h(T₂)、2 h(T₃)、6 h(T₄)、12 h(T₅)和拔管后10 min(T₆)各时间点Ramsay镇静评分和BPS镇痛评分以及生命体征;记录各组患者不良反应发生率。采用SPSS 19.0软件包对数据进行统计学分析。结果: 咪达唑仑、右美托咪定和丙泊酚Ramsay评分差异无统计学意义(P>0.05)。在T₃、T₄、T₅时,右美托咪定组BPS评分均显著低于咪达唑仑组和丙泊酚组(P<0.05)。3组患者低血压发生率差别无统计学意义(P>0.05);心动过缓发生率右美托咪定组显著高于与丙泊酚和咪达唑仑组(P<0.05);右美托咪定组和丙泊酚组患者并发躁动的人数显著低于咪达唑仑组(P<0.05)。结论: 右美托咪定和咪达唑仑、丙泊酚均能满足ICU患者的镇静需要,且右美托咪定具有一定的镇痛作用,可减少ICU患者躁动发生率。

Comparison among dexmedetomidine,propofol and midazolam for sedation in patients with intubation after oral and maxillofacial surgery

PURPOSE: Due to adjacent to the airway, oral and maxillofacial surgery is more common and serious to have emergency airway than other surgeries. The aim of this study was to clarify the beneficial sedative effects for patients with postoperative intubation in the intensive care unit (ICU) after oral and maxillofacial surgery. METHODS: Sixty patients with postoperative intubation were divided into 3 groups using random number table: midazolam group, propofol group and dexmedetomidine group. Ramsay score, behavioral pain scale(BPS) score, SpO₂, HR, MAP, and RR were recorded before sedation, 30 min(T₁), 1 h(T₂), 2 h(T₃), 6 h(T₄), and 12 h(T₅) after sedatives initiation in ICU, and 10 min after extubation (T6). The rate of incidences of side effects was calculated. The data were analyzed with SPSS 19.0 software package. RESULTS: Midazolam, dexmedetomidine and propofol had similar sedative effect. BPS score in dexmedetomidine group was significantly lower than that in propofol group and midazolam group at time point of T₃, T₄ and T₅ (P<0.05). The incidence of bradycardia in dexmedetomidine group was significantly higher than that in midazolam group and propofol group (P<0.05). There was no significant difference in the incidence of hypotension among 3 groups (P>0.05). The number of restlessness in dexmedetomidine group and propofol group was significantly lower than that in midazolam group(P<0.05). CONCLUSIONS: Dexmedetomidine and midazolam can meet the needs for sedation in ICU patients. Dexmedetomidine can improve patients' ability to communicate pain compared with midazolam.