BIS监测下持续静脉泵注右美托咪定或咪达唑仑用于ICU老年心脏手术患者机械通气的镇静效果

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• 论文作者：董万超 ; 李伟伟 ; 康晓燕
• 年：2017
• 作者机构：许昌市中心医院呼吸内科;
• 论文关键词：脑电双频谱指数 ; 右美托咪定 ; 咪达唑仑 ; 机械通气 ; 镇静
• 会议召开时间：2017-05-26
• 会议录名称：2017年《中国组织化学与细胞化学杂志》临床研讨会论文集
• 语种：中文
• 分类号：R654.2
• 学会代码：ZHXB
• 会议名称：2017年《中国组织化学与细胞化学杂志》临床研讨会
• 会议地点：中国湖北武汉
• 主办单位：《中国组织化学与细胞化学杂志》社有限公司
• 学会名称：《中国组织化学与细胞化学杂志》社有限公司
• 页数：2
• 文件大小：239k
• 原文格式：O
• 会议级别：全国

摘要

目的:探讨脑电双频谱指数监测下持续静脉泵注右美托咪定或咪达唑仑用于老年心脏手术患者术后机械通气的镇静效果。方法:择期行瓣膜置换手术并于术后带气管导管进入ICU的老年患者68例,平均随机分为2组,右美托咪定组(D组)和咪达唑仑组(M组),记录泵注镇静药物前、泵注药物后1h、2h、3h时2组患者各时点的平均动脉压(MAP),呼吸频率(RR),脉搏氧饱和度(SpO_2),心率(HR),改良警觉/镇静评分(MOAA/S),脑电双频指数(BIS),脱机时间以及不良反应。药物泵注3h后将BIS值控制在61~75,并根据BIS值调整药物泵注的速度。结果:2组患者在实施不同的镇静方案后各时点MAP、RR、SpO_2、HR、MOAA/S评分差异无统计学意义。与镇静前相比,2组患者RR、HR降低(P<0.05),MOAA/S升高(P<0.05),D组患者实施镇静后各时间点BIS、MOAA/S显著高于M组(P<0.05),低血压、心动过缓等不良反应的发生率低于M组(P<0.05),D组患者自转入ICU至开始脱机的时间、脱机时间显著短于M组(P<0.05)。结论:右美托咪定和咪达唑仑低剂量静脉泵注对ICU患者术后持续机械通气均具有良好的镇静效果,但在等效镇静水平下,右美托咪定脱机时间更短,不良反应发生率更低。
Objective:To evaluate the sedative efficiency of continuous infusion of dexmidetomidine or midazolam on mechanical ventilation with BIS in elder patients underwent cardiac surgery.Methods:Sixty-eight elder patients underwent postoperative mechanical ventilation after cardiac surgery were admitted to ICU and randomly assigned to two separate groups,dexmidetomidine group(Group D) or midazolam(Group M).Compared MAP、RR、SpO2、HR、MOAA/S and BIS premedication,1h、2h、3h during the ventilation postoperatively.BIS index was maintain between 61 to 75 during ventilation procedure in every patient after sedatives were infused for 3 hours.Results The comparison of MAP、RR、SpO、HR、MOAA/S at corresponding time points during mechanical ventilation procedure were not statistically significant.Compared with premedication,RR、HR were significantly decreased in both groups(P <0.05),BIS、MOAA/S increased(P< 0.05).MOAA/S was higher in Gourp D than in Group M during ventilation(P < 0.05).The incidence of hypotension and bradycardia were lower in Group D than in Group M(P <0.05).Time duration from ICU admission to enablement of off-line program and off-line period were shorter in Group D than in Group M(P < 0.05).Conclusion:Continuous infusion of low dose dexmidetomidine or midazolam facilitates the sedative effect in patients with mechanical ventilation in ICU.Under the equivalent level of sedation,Dex could shorten time duration for ventilation,and decrease the incidence of adverse reactions.

引文

[1]Baron R,Binder A,Biniek R,et al.Evidence and consensus based guideline for the management of delirium,analgesia,and sedation in intensivecare medicine.Revision 2015(DAS-Guideline 2015)-short version[J].Ger Med Sci.2015 Nov 12;13:Docl9.
    [2]Bilgili B,Montoya JC,Layon AJ,et al.Utilizing bi-spectral index(BIS)for the monitoring of sedated adult ICU patients;a systematic review[J].Minerva Anestesiol.2016,In Press.
    [3]陈正,邵东华,杭黎华.右美托咪啶对靶控输注丙泊酚镇静时量效关系的影响[J].中国现代医学杂志,2013,23(14):71-74.
    [4]焦薇,周脉涛,吴文华,等.右美托咪定与咪唑安定对重型颅脑外伤患者围术期炎症反应及颅内压的影响[J].中国现代医学杂志,2014,24(17):34-38.
    [5]万林骏,黄青青,岳锦熙,等.右美托咪啶与咪达唑仑用于外科重症监护病房术后机械通气患者镇静的比较研究[J].中国危重病急救医学,2011,23(9):543-546.
    [6]张旭静,黄久仪,王桂清.血流动力学与动脉粥样硬化[J].国际脑血管疾病杂志,2006,14(3):228-230.