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目的探讨右美托咪定用于重症监护病房(ICU)正颌外科术后留置气管插管患者镇静作用的有效性和安全性。方法 40例正颌外科术后入ICU留置气管插管患者,随机分为右美托咪定组和咪达唑仑组,每组20例。右美托咪定组予右美托咪定0.4μg·kg~(-1)·h~(-1)微泵静注,调整范围0.2～0.7μg·kg~(-1)·h~(-1);咪达唑仑组予咪达唑仑0.1 mg·kg~(-1)·h~(-1)微泵静注,调整范围0.05～0.2 mg·kg~(-1)·h~(-1)。采用Ramsay镇静深度评分系统,以Ramsay评分2～4分级为镇静目标,进行注射剂量的调整。记录用药前,用药后1、2、3、4、6、8、12、16 h的血压、心率、呼吸、脉搏血氧饱和度,观察镇静效果及不良反应。结果 2组患者用药后均可获得满意的镇静效果,Ramsay评分维持在2～4分级,良好耐受气管插管。2组用药前心率、平均动脉压(MAP)无显著差异(P>0.05),用药后心率和血压均有所下降,右美托咪定组各时点心率均低于咪达唑仑组(P<0.05),用药后1、2、3、4 h MAP低于咪达唑仑组(P<0.05)。2组呼吸频率、脉搏血氧饱和度无显著差异(P>0.05)。右美托咪定组需剂量调整的次数(2例1次)较咪达唑仑组(3例1次,4例2次)低。右美托咪定组发生2例心动过缓,予以阿托品治疗好转,2组均无严重不良反应发生。结论右美托咪定0.4μg·kg~(-1)·h~(-1)可安全用于ICU正颌外科术后留置气管插管患者的镇静,剂量调整发生率低于咪达唑仑。
Objective To investigate the efficacy and safety of dexmedetomidine for sedation in patients with indwelling tracheal intubation after orthognathic surgery in intensive care unit (ICU). Methods Forty cases of orthognathic surgery patients admitted to the ICU after intubation were randomly divided into dexmedetomidine group and midazolam group, with 20 cases in each group. The dexmedetomidine group was given dexmedetomidine 0.4 μg · kg -1 h -1 micro-pump for intravenous injection, with the adjustment range of 0.2-0.7 μg · kg -1 · h -1 -1). Midazolam group was given midazolam 0.1 mg · kg -1 · h -1 by micro-pump, the range of adjustment was 0.05-0.2 mg · kg -1 · h ~ (-1). Using Ramsay sedation depth scoring system to Ramsay score 2 to 4 grades for the sedation goal, the injection dose adjustment. Record the blood pressure, heart rate, respiration and pulse oximetry before treatment, 1, 2, 3, 4, 6, 8, 12 and 16 h after treatment, and observe the sedation and adverse reactions. Results The two groups of patients received satisfactory sedation after treatment, Ramsay score maintained at 2 to 4 grade, well tolerated endotracheal intubation. The heart rate and mean arterial pressure (MAP) were not significantly different between the two groups before treatment (P> 0.05). The heart rate and blood pressure decreased after treatment. The heart rate of dexmedetomidine group was lower than that of midazolam group P <0.05). The MAP of 1,2,3,4 h after administration was lower than that of midazolam group (P <0.05). There were no significant differences in respiratory rate and pulse oximetry between the two groups (P> 0.05). Dexmedetomidine group required dose adjustment (2 cases 1) than the midazolam group (3 cases 1, 4 cases 2 times) lower. Dexmedetomidine group 2 cases of bradycardia, to be atropine treatment improved, two groups were no serious adverse reactions. Conclusion Dexmedetomidine 0.4 μg · kg -1 · h -1 can be safely used for the sedation of patients with indwelling tracheal intubation after orthognathic surgery in ICU. The incidence of dose adjustment is lower than that of midazolam .