右旋美托咪啶用于需机械通气的口腔癌术后患者镇静的观察

目的：比较右旋美托咪啶与咪达唑仑用于需机械通气的口腔癌术后患者镇静的安全性与有效性。方法将30位口腔癌根治术后需机械通气超过24 h的患者随机分为Dex组与Mid组，分别给予0.2~1.0μg·kg^-1·h^-1的右旋美托咪啶和0.02~0.1 mg·kg^-1·h^-1的咪达唑仑，以维持患者轻中度镇静（ RASS评分-3~0）。记录患者达到目标镇静程度的时间百分比、谵妄发生率、机械通气时间、用药时间、拔管时间、ICU停留时间和不良事件。结果 Dex组达到目标镇静深度的时间明显长于Mid组（P﹤0.05）；Dex组的机械通气时间、拔管时间明显短于Mid组（P﹤0.05）。两组谵妄发生率、ICU停留时间相似（P﹥0.05）。结论右旋美托咪啶延长患者达到镇静目标评分的时间，减少芬太尼的用量，缩短机械通气时间和拔除气管导管时间。但是，要注意右旋美托咪啶可以引起窦性心动过缓和低血压，应用时应加强监测。

Dexmedetomidine for Sedation in Patients with Mechanical Ventilation after Oral Cancer Operation

Objective To compare the efficacy and safety of dexmedetomidine with midazolam in mechanically ventilated patients after oral cancer operation. Methods 30 oral cancer patients with expected mechanical ventilation more than 24 h after radical oral cancer surgery were randomly assigned to Dex group（dexmedetomidine 0. 2~1. 0 μg· kg^-1·h^-1）and Mid group（midazolam 0. 02~0. 1 mg·kg^-1·h^-1）in order to achieve mild-to-moderate sedation （RASS score -3~0）. Percentage of time to achieve target sedation,incidence of delirium,time of mechanical venti-lation,medication time,extubation time,duration of stay in ICU and adverse events were recorded. Results Time to achieve target sedation was longer in Dex group（P﹤0. 05）. Time of mechanical ventilation and extubation time were shorter in Dex group（P﹤0. 05）. There were no significant difference in incidence of delirium and duration of stay in ICU between these two groups（P﹥0. 05）. Conclusion Dexmedetomidine can prolong percentage of time to achieve target sedation,decrease the dose of fentanyl,shorten time of mechanical ventilation and extubation time. However, dexmedetomidine can induce sinus bradycardia and hypotension,which should be monitored in application.