右美托咪定用于口腔颌面肿瘤术后患者镇静及镇痛的临床观察

目的:探讨右美托咪定(DEX)对口腔颌面肿瘤术后保留气管套管患者镇静及镇痛的作用。方法:将口腔颌面肿瘤术后保留气管套管的60例患者按照随机原则分为右美托咪定Ⅰ组(D1组,20例)、右美托咪定Ⅱ组(D2组,20例)和生理盐水组(C组,20例)。D1组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10 min输注完毕,然后以0.2μg/(kg.h)维持;D2组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10 min内输注完毕,然后以0.4μg/(kg.h)维持;C组给予同等剂量的0.9%氯化钠输注。比较3组患者的Ramsay评分、疼痛情况、心率、血压、呼吸等变化。采用SPSS11.0软件包对数据进行统计学处理。结果:在各时点,3组的呼气末二氧化碳分压(ETCO2)无显著差异(P>0.05);在T2～T4时,D1组、D2组的Ramsay评分显著高于C组(P<0.05),D2组的Ramsay评分也显著高于D1组(P<0.05);在T4时,D1组、D2组的VAS评分显著高于C组(P<0.05),D2组的VAS评分也显著高于D1组(P<0.05)。结论:静脉输注右美托咪定用于口腔颌面肿瘤术保留气管套管患者镇静安全、镇痛有效,且无明显不良反应,推荐剂量为负荷剂量0.5μg/kg后,以0.4μg/(kg.h)维持输注。

Clinical observation of dexmedetomidine on sedation and analgesia in patients after surgical treatment of oral and maxillofacial tumors

PURPOSE： To investigate sedation, analgesic effect of dexmedetomidine given to oral and maxillofaeial tumor postoperative patients with tracheostomy tube. METHODS： Sixty patients after surgical treatment of oral and maxillofaeial tumors with tracheostomy tube were randomly divided into DEX I （D1） group, DEX Ⅱ （D2） group or saline （C） group with 20 patients in each group. DEX I （D1） group was given a loading dose of intravenous infusion of dexmedetomidine at 0.5 μg/kg, 10 rain, and then maintained with 0.2 μg/（kg.h）; DEX Ⅱ （D2） group received a loading dose of intravenous infusion of dexmedetomidine at 0.5μg/kg, 10 rain, and then maintained with 0.4μg/（kg.h）; saline （C） group received the same dose of 0.9% sodium chloride. Ramsay score, pain conditions, heart rate, blood pressure, respiratory and other changes were compared among 3 group before administration （To）, l0 minutes after administration （T1）,6 hours after administration（T2）,12 hours after administration （T3） and 24 hours after administration （T4）. The data was processed with SPSS 11.0 software package. RESULTS： There was no significant difference for ETCO2among the three groups at all time points （/：＇〉0.05）. At T2-T4,Ramsay score of DEX I （D1） group and DEX Ⅱ （D2） group was significantly higher than saline （C） group（P〈0.05）. Ramsay score of DEX Ⅱ （D2） group was significantly higher than DEX I （D1） group （P〈0.05）. At T4, VAS score of DEX I （D1） group and DEX Ⅱ （D2） group was significantly higher than saline （C） group（P〈0.05）. VAS score of DEX Ⅱ （D2） group was significantly higher than DEX I （D1） group （P〈0.05）. CONCLUSION： Dexmedetomidine used in postoperative oral and maxillofacial tumor patients with tracheostomy tube is safe and effective for sedation and analgesia without significant adverse reactions. Its recommended dose is a loading dose of intravenous infusion of dexmedetomidine at 0.5 μg/kg, 10 rain, and then maintained with 0.4 μg/（kg.h）.