单一剂量右美托咪定在慢性阻塞性肺病患者撤机中的应用

目的:研究应用单一剂量右美托咪定对慢性阻塞性肺病(COPD)患者拔除气管插管期间的影响。方法:选择COPD合并呼吸衰竭经呼吸机治疗后欲拔除气管插管的40例患者,分为观察组和对照组,各20例。观察组患者拔管前予以0.5μg/kg负荷剂量的右美托咪定,10min注射完毕后开始拔管。监测并记录2组患者用药前(T0)、拔管前(T1)、吸痰后(T2)、拔管后(T3)、拔管后5min(T4)、拔管后10min(T5)、拔管后30min(T6)的呼吸、心率、收缩压、动脉血二氧化碳分压(PaCO2)、氧分压(PaO2)和24h内重插管上机例数。结果:2组患者用药前一般资料和生命体征及血气之间无显著差异;用药导致观察组患者SBP、HR下降,但不影响RR、PaCO2、PaO2;此剂量用药不能完全抑制拔管时吸痰所造成的交感兴奋,但可以减轻幅度,减少再插管率。结论:0.5μg/kg负荷剂量的右美托咪定用于COPD患者脱机时拔管,心血管稳定性较好,在不影响患者呼吸的前提下,有效减轻患者拔管时的血流动力学剧烈变化和继发的二氧化碳潴留及低氧血症,并可能减少由此引发的脱机失败。

Application of single-dose of dexmedetomidine in patients with chronic obstructive pulmonary disease during extubation

Objective:To study the effects of single-dose of dexmedetomidine on patients with chronic obstructive pulmonary disease(COPD) during extubation.Methods:Fourty patients with COPD complicated with respiratory failure who had to withdraw tracheal tube after mechanical ventilation were divided into observation group and control group(20 cases for each group).Patients in observation group were administered with a 0.5μg/kg loading dose of intravenous infusion of dexmedetomidine 10 minutes before extubation.The respiratory rate(RR),heart rate(HR),systolic blood pressure(SBP),arterial carbon dioxide partial pressure(PaCO2),and arterial oxygen partial pressure(PaO2),the numbers of patient needing reintubation and mechanical ventilation within 24 hours were monitored and recorded before dexmedetomidine administration(T0),before extubation(T1),after sputum suction(T2),and after extubation instantly(T3),5 minutes later(T4),10 minutes later(T5) and 30 minutes later(T6) in both groups.Results:There were no significant difference in patients’ general information,vital signs and blood gas index between two groups before drug administration.Dexmedetomidine administration decreased SBP and HR in observation group,but it did not influence RR,PaCO2 and PaO2.A 0.5μg/kg loading dose of dexmedetomidine did not completely suppress sympathomimetic excitation related with sputum suction in the course of extubation,whereas it reduced the extent of excitation and the rate of final reintubation.Conclusions:The cardiovascular stabilities in the course of extubation in patients with COPD were better with a 0.5μg/kg loading dose of dexmedetomidine.It can efficiently reduce the intensity of hemodynamic changes,secondary carbon dioxide retention,and hyoxemia in the course of extubation without causing respiratory depression,and decrease possibly secondary failure of weaning off meachanical ventilator.