盐酸瑞芬太尼联合右美托咪啶用于ICU高血压脑出血患者术后镇静镇痛中的价值研究
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摘要
目的研究将盐酸瑞芬太尼与右美托咪啶联合应用于ICU高血压脑出血患者手术之后镇静镇痛的效果。方法选择从2015年11月—2017年10月在该院进行高血压脑出血手术治疗的患者共120例进行该次观察研究。采用随机数字表的方法把这些患者分成两组,两组患者数目相同。其中,采取盐酸瑞芬太尼和咪达挫仑进行手术之后镇静镇痛的一组患者作为对照组,联合使用盐酸瑞芬太尼与右美托咪啶进行镇静镇痛的一组患者作为实验组。比较不同组患者手术之后不同时间段各项生命指标的变化以及脑出血的复发率。结果该次研究结果显示,实验组T_2、T_3、T_4时间点心率、SBP、DBP分别为[(70±12)、(71±13)、(69±8)次/min]、[(123±9)、(121±11)、(120±8)mmHg]、[(72±14)、(70±9)、(62±12)mmHg],均显著优于对照组(t=13.18,10.44,16.57,27.12,29.48,21.33,10.46,11.37,10.46,P=0.026,0.035,0.029,0.001,0.002,0.013,0.029,0.016,0.034<0.05);且实验组复发率为3.33%,显著低于对照组23.33%,差异有统计学意义(χ~2=9.314,P=0.001 5)。结论将盐酸瑞芬太尼与右美托咪啶联合应用于ICU高血压脑出血患者手术之后的镇静镇痛之中,患者生命指标波动小,脑出血的复发率低,有优良的临床应用前景。
Objective To research the value of remifentanil hydrochloride combined with dexmedetomidine in the postoperative sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage. Methods 120 cases of patients with hypertensive cerebral hemorrhage admitted and treated in our hospital from November 2015 to October 2017 were selected and randomly divided into two groups with 60 cases in each, the control group used the remifentanil hydrochloride and midazolam, while the experimental group used the remifentanil hydrochloride and dexmedetomidine,and the changes of various vital signs and recurrence rate of cerebral hemorrhage were compared between the two groups. Results The research results showed that the heart rate, SBP and DBP at T_2, T_3, T_4 in the experimental group were respectively [(70±12),(71±13),(69±8)times/min],[(123±9),(121±11),(120±8)mmHg,(72±14),(70±9),(62±12)mmHg,which were obviously better than those in the control group(t =13.18,10.44,16.57,27.12,29.48,21.33,10.46,11.37,10.46,P=0.026,0.035,0.029,0.001,0.002,0.013,0.029,0.016,0.034 <0.05, and the recurrence rate in the experimental group was obviously lower than that in the control group,(3.33% vs 23.33%), and the difference was obvious(χ~2=9.314, P =0.001 5). Conclusion The application of remifentanil hydrochloride and dexmedetomidine for postoperative sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage can have a small fluctuation of vital indexes and low recurrence rate of cerebral hemorrhage, and the clinical application prospect is excellent and good.
Objective To research the value of remifentanil hydrochloride combined with dexmedetomidine in the postoperative sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage. Methods 120 cases of patients with hypertensive cerebral hemorrhage admitted and treated in our hospital from November 2015 to October 2017 were selected and randomly divided into two groups with 60 cases in each, the control group used the remifentanil hydrochloride and midazolam, while the experimental group used the remifentanil hydrochloride and dexmedetomidine,and the changes of various vital signs and recurrence rate of cerebral hemorrhage were compared between the two groups. Results The research results showed that the heart rate, SBP and DBP at T_2, T_3, T_4 in the experimental group were respectively [(70±12),(71±13),(69±8)times/min],[(123±9),(121±11),(120±8)mmHg,(72±14),(70±9),(62±12)mmHg,which were obviously better than those in the control group(t =13.18,10.44,16.57,27.12,29.48,21.33,10.46,11.37,10.46,P=0.026,0.035,0.029,0.001,0.002,0.013,0.029,0.016,0.034 <0.05, and the recurrence rate in the experimental group was obviously lower than that in the control group,(3.33% vs 23.33%), and the difference was obvious(χ~2=9.314, P =0.001 5). Conclusion The application of remifentanil hydrochloride and dexmedetomidine for postoperative sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage can have a small fluctuation of vital indexes and low recurrence rate of cerebral hemorrhage, and the clinical application prospect is excellent and good.
引文
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[2]占霖森.右美托咪啶复合舒芬太尼在脑出血患者开颅手术中的应用[J].浙江创伤外科,2013,18(4):595-597.
[3]杨旺东,王超.右美托咪啶对老年颅脑手术全身麻醉患者唤醒试验质量的影响[J].中国老年学杂志,2015,35(17):4946-4948.
[4]张明德,王敏.静吸复合全麻与靶控输注对老年高血压患者麻醉深度的影响[J].中国老年学杂志,2014,34(20)5748-5749.
[5]张冰峰.右美托咪啶复合盐酸瑞芬太尼对高血压脑出血患者术后镇静镇痛中的应用研究[J].临床医药文献杂志,2016,3(49):9844.
[6]吴德华.右美托咪啶对开胸手术患者围术期末梢灌注指数和心率变异性的影响[J].中华麻醉学杂志,2013,33(9):1044-1046.
[7]彭七华,周伟,辜雄军,等.持续输注右美托咪啶对丙泊酚复合瑞芬太尼静脉麻醉用药量的影响[J].检验医学与临床,2016,13(zl):250-251.
[8]朱莉娅.右美托咪啶复合丙泊酚与瑞芬太尼应用于脑动脉瘤夹闭术患者麻醉效果观察[J].中国实用神经疾病杂志,2016,19(24):76-78.
[9]揭红英,李云祥,叶纪录.右美托咪啶复合盐酸瑞芬太尼在ICU高血压脑出血患者术后镇静镇痛中的应用[J].中华急诊医学杂志,2015,24(12):1368-1372.
[10]胡益岚,汤崇辉,方战舰,等.右美托咪啶在高血压脑出血患者术后镇静镇痛中的应用[J].浙江医学,2014(10):902-903.