右美托咪啶在心脏术后患者中应用的临床研究

目的：研究右美托咪啶用于ICU心脏术后患者的镇静效果及安全性。方法：选择收住我院重症监护病房（ICU）心脏术后需机械通气的患者13例,随机分为右美托咪啶组（n=6）和丙泊酚组（n=7）,两组分别给予右美托咪啶和丙泊酚镇静治疗并同时给予吗啡镇痛,镇静目标为Ramsay评分2-4分。监测用药期间呼吸频率、心率、血压、脉搏血氧饱和度,并记录镇静药物剂量、机械通气时间、停药后唤醒时间、意外拔管情况以及镇静药物相关并发症（谵妄、低血压、心动过缓）。结果：两组患者镇静达标时间的比例无显著差异（P〉0.05）,右美托咪啶组停药后躁动的比例明显少于丙泊酚组（0%比28.57%,P〈0.05）,右美托咪啶组谵妄发生率明显少于丙泊酚组（0%比14.28%,P〈0.05）,两组机械通气时间无明显差异[（10.51±5.11）h比（11.07±4.91）h,P〉0.05],两组意外拔管率无明显差异（0%比0%,P〉0.05）。两组患者低血压发生率（33.33%比42.86%,P〉0.05）、需要干预的低血压比例（16.67%比28.57%,P〉0.05）均无显著差异,两组心动过缓发生率（33.33%比28.57%,P〉0.05）无显著差异。结论 ：右美托咪啶用于心脏术后患者能够实现镇静目标,对呼吸、循环无显著影响,可安全使用。

Clinical Evaluation of Dexmedetomidine for Patients after Cardiac Surgery

Objective ：To study sedative effect and safety of dexmedetomidine for patients in ICU after cardiac surgery . Methods ：There were 13 cases after cardiac surgery with endotracheal intubation mechanical ventilation in ICU ,we used the random digits table ,and the patients were randomly divided into two groups ：dexmedetomidine group（n=6） and propofol group（n=7） .Both groups were treated with conventional administration of morphine ;they were given dexme‐detomidine and propofol for sedation respectively ,the dose of sedation was regulated by Ramsay score ,maitain 2-4 sedative score .During the course ,respiratory rate ,blood pressure ,heart rate and oxygen saturation were observed . The drug dosage ,time of mechanical ventilation ,awake time ,incidence of unplanned extubation ,incidence of side-effects such as delirium ,bradycardia ,and hypotension ,were recorded in two groups .Results：There were no differences in the ratio of taking expected sedative score （P〈0 .05） ,in the patients treated with dexmedetomidine ,the ratio of agitation after stopping drug was clearly lower （0% VS 28 .57% ,P〉0 .05） ,the rates of delirium showed a clearly decrease（0% VS 14 .28% ,P〉 0 .05） .But there were no significant difference in duration of mechanical ventilation [（10 .51 ± 5 .11）h VS （11 .07 ± 4 .91）h ,P〈0 .05] ,incidence of unplanned extubation （0% VS 0% ,P〈0 .05）between two groups .The incidence of hypotension showed no significant difference between two groups （33 .33% VS 42 .86% , P〈0 .05） .And there were no significant difference in the incidence of bradycardia （33 .33% VS 28 .57% ,P〈0 .05） . Conclusion ：Sedative effect of dexmedetomidine is satisfactory for patients after cardiac surgery .It has no significant side effect on respiration and circulation .Dexmedetomidine is safe to use for patients after cardiac surgery .