右美托咪啶在ICU镇静作用的临床效果分析

目的观察右美托咪啶在ICU镇静治疗的效果及安全性．方法选择全麻腹部手术后保留气管插管转入ICU患者40例，将其随机分为右美托咪啶组（D组，20例）和咪达唑仑组（M组，20例）．D组予右美托咪啶负荷量1μg／kg经中心静脉泵注射20min，每1h依据Ramsay评分调整药物泵入剂量为0．2～0．7μg／（kg．h）；M组予咪达唑仑负荷剂量0．05mg／kg静脉1min推注完，根据不同镇静程度维持剂量为0．02～0．1mg／（kg．h）.每2h进行疼痛数字评分（NRS），当NRS评分〉4分时，加用芬太尼1μg／kg．达到脱机条件者拔出气管导管．比较2组患者的镇静效率，芬太尼用量，停药后唤醒时间、拔管时间、机械通气时间，心血管事件及谵妄发生率．结果D组镇静效率明显高于M组（P〈0．05）；与M组比较，D组芬太尼用量明显减少（P〈0．05），停药后唤醒时间、拔管时间明显缩短（P〈0．05）；两组用药期间心血管事件发生率差异无统计学意义（P〉0．05）；D组术后谵妄发生率明显低于M组（P〈0．05）．结论右美托咪啶用于ICU患者，镇静、镇痛效果好，易唤醒，可缩短拔管时间，且血流动力学稳定，谵妄发生率低，是较理想的ICU镇静剂．

Clinical Study of Dexmedetomidine Sedation in the ICU

Objective To observe the therapeutic effect and safety of dexmedetomidine for sedation in ICU. Methods We selected 40 patients who transferred to the ICU with retained endotracheal intubation after abdominal surgery under general anesthesia in this study. 40 patients were randomly divided into the dexmedetomidine group （D group, 20 cases） and midazolam group （M group, 20 cases） . Patients in group D were treated with loading dose 1 μg/kg from central vein pump injection 20 rain, lh according to Ramsay score for each adjustment of drug dose is pumped into 0.2 - 0.7 μg/（kg.h）. Patients in M group were given a loading dose of midazolam 0.05mg/kg intravenous injection 1 rain, depending on the degree of sedation maintenance dose of 0.02 - 0.1 mg/（kg.h）. Pain scores every 2 h （NRS） , when the NRS score〉4 sharing, plus fentanyl 1 μg/kg. When the patients achieved the offline condition, the endotracheal tube was pulled out. The sedation efficiency, dosage of fentanyl, after discontinuation wake-up time, extubation time, duration of mechanical ventilation, the incidence of cardiovascular events and delirium were compared between two groups. Results The sedation efficacy in Group D sedation was significantly higher than in group M （P〈0.05） . Compared with group M, the dosage of fentanyl in patients in D group was significantly reduced （P〈0.05） , the wake time after stopping, extubation time were significantly shorter （P〈0.05） . The incidence of cardiovascular events has no significant difference between two groups during the treatment. The incidence of postoperative delirium in D group was significantly lower than in that in group M （P〈0.05） . Conclusions extubation with hemodynamic stability sedative. Dexmedetomidine and low incidence has good sedative effect, of delirium for patients in and can shorten the time of the ICU. It is an ideal ICU sedative.