口腔医学研究

口腔医学研究 ›› 2018, Vol. 34 ›› Issue (2): 157-160.DOI: 10.13701/j.cnki.kqyxyj.2018.02.012

• 口腔肿瘤学研究 • 上一篇    下一篇

右美托咪定用于口腔癌前臂皮瓣修复术后保留气管插管患者的镇静研究

王丽, 李建国*   

  1. 武汉大学中南医院重症医学科 湖北 武汉 430071;
  • 收稿日期:2017-10-09 出版日期:2018-02-28 发布日期:2018-02-26
  • 通讯作者: 李建国,E-mail:drljg181@yahoo.com.cn
  • 作者简介:王丽(1981~ ),女,湖北武汉人,硕士,主治医师,现工作于武汉大学口腔医院麻醉科。

Sedative Effects of Dexmedetomidine for Patients Retained with Tracheal Intubation after Repair of Forearm Flap in Oral Cancer

WANG Li, LI Jian-guo*   

  1. Intensive Care Unit, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.
  • Received:2017-10-09 Online:2018-02-28 Published:2018-02-26

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摘要： 目的:探讨右美托咪定用于口腔癌前臂皮瓣修复术后留置经鼻气管导管患者在重症监护病房(ICU)的镇静效果及其安全性。方法:将口腔癌前臂皮瓣修复术后留置经鼻气管导管患者40例按照随机数字表法为2组:咪达唑仑组(A组,20例)、右美托咪定组(B组,20例)。分别记录2组镇静药物起效时间和药物停用后患者苏醒的时间;记录患者入ICU直至拔出气管道期间2组患者所需镇痛药物总的剂量; 记录入ICU镇静前(T0)和镇静开始后30 min(T1)、1 h(T2)、2 h(T3)、6 h(T4)、12 h(T5)和拔管后10 min(T6)各时间点Ramsay镇静评分;记录各组呼吸抑制发生率、需要治疗的心动过缓发生率、需要治疗的低血压发生率;记录谵妄发生率;记录治疗期间病死率。结果:咪达唑仑和右美托咪定均能使病人Ramsay 评分达到2~4分;停药后苏醒时间右美托咪定较咪达唑仑组快(P＜0.05);右美托咪啶组所需镇痛药总剂量少于咪达唑仑组;呼吸抑制率咪达唑仑组明显高于右美托咪啶组( P＜0.05);右美托咪定组患者并发谵妄的人数明显低于咪达唑仑组。结论:在一定剂量范围内,右美托咪啶和咪达唑仑均能满足ICU患者的镇静需要;并且右美托咪啶具有镇痛作用,减少呼吸抑制发生;另外与咪达唑仑相比,右美托咪啶可减少ICU患者的谵妄发生率。

关键词: 右美托咪定, 咪达唑仑, 镇静, 镇痛

Abstract: Objective: To investigate the sedative effect and safety of dexmedetomidine for patients with indwelling nasal tracheal duct in the intensive care unit (ICU) after oral forearm flap repair. Methods: Forty patients with oral nasal tracheal ducts who underwent oral forearm flap repair were divided into two groups randomly. The sedative drug onset time to reach the target sedation range and the time the patients were awake after the drug had been withdrawn were recorded. The total dosage of the sedative drug for both groups was recorded. The Ramsay sedation scores before using sedative (T0), 30 min (T1), 1 h (T2), 2 h (T3), 6 h (T4), and 12 h (T5) after injection of sedative and 10 min (T6) after extubation were recorded. The incidence of respiratory depression, and bradycardia and hypotension was recorded. The incidence of delirium was recorded. The mortality during treatment was recorded. Results: Midazolam and dexmedetomidine both resulted in a Ramsay score within 2-4. The recovery time of dexmedetomidine was significantly faster than that of midazolam (P＜0.05). The total dosage of analgesics required in the dexmedetomidine group was less than that in the midazolam group (P＜0.05). Midazolam may be more likely to cause respiratory depression (P＜0.05). The number of patients who have delirium in midazolam group was significantly lower than that in the dexmedetomidine group (P<0.05). Conclusion: In a certain range of dosage, dexmedetomidine and midazolam can meet the needs for sedation in ICU patients. And dexmedetomidine has analgesic effect. Dexmedetomidine can reduce the incidence of delirium in ICU patients.

Key words: Dexmedetomidine, Midazolam, Sedation, Analgesic

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