本文選題：右美托咪定 + 丙泊酚　； 參考：《第二軍醫(yī)大學(xué)學(xué)報(bào)》2017年05期

【摘要】：目的比較右美托咪定與丙泊酚對(duì)心臟瓣膜術(shù)后機(jī)械通氣患者的鎮(zhèn)靜效果及血流動(dòng)力學(xué)的影響。方法選取60例心臟瓣膜術(shù)后機(jī)械通氣患者,隨機(jī)分為右美托咪定組(D組)30例和丙泊酚組(P組)30例,D組給予右美托咪定0.2~0.7μg/(kg·h)+舒芬太尼0.15μg/(kg·h),P組給予丙泊酚1.2~3.0 mg/(kg·h)+舒芬太尼0.15μg/(kg·h)。以腦電雙頻指數(shù)(BIS)值為70~85、Richmond躁動(dòng)鎮(zhèn)靜評(píng)分(RASS)-2~-3分為鎮(zhèn)靜目標(biāo)。分別于術(shù)前(T_1)、心肺轉(zhuǎn)流(CPB)結(jié)束后2 h(T_2)、術(shù)后4 h(T_3)和術(shù)后12 h(T_4)測(cè)定患者血流動(dòng)力學(xué)相關(guān)指標(biāo)。比較兩組患者各觀察時(shí)間點(diǎn)的BIS值、RASS評(píng)分以及平均動(dòng)脈壓(MAP)下降、心動(dòng)過(guò)緩、躁動(dòng)或譫妄等不良反應(yīng)發(fā)生率。結(jié)果兩組患者鎮(zhèn)靜后的BIS值與RASS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者鎮(zhèn)靜后血流動(dòng)力學(xué)變化存在差異,MAP有不同程度的下降,在T_2時(shí)間點(diǎn),P組的MAP小于D組(P0.05);在T_3、T_4時(shí)間點(diǎn),D組心指數(shù)(CI)高于P組(P0.05,P0.01)。在T_2、T_3、T_4時(shí)間點(diǎn),P組的動(dòng)脈血乳酸含量較D組升高明顯(P0.05,P0.01)。兩組間T_1~T_4各時(shí)點(diǎn)的全身血管阻力指數(shù)(SVRI)、每搏輸出量(SV)、右心室射血分?jǐn)?shù)(RVEF)、混合靜脈血氧飽和度(Sv O2)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組各血管活性藥物用量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)后MAP下降、心動(dòng)過(guò)緩發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),D組鎮(zhèn)靜過(guò)程中躁動(dòng)及譫妄發(fā)生率低于P組(P0.05)。結(jié)論兩組患者均可取得較好的鎮(zhèn)靜效果。右美托咪定對(duì)血流動(dòng)力學(xué)影響較小,且其用于術(shù)后鎮(zhèn)靜可降低躁動(dòng)或譫妄的發(fā)生率。右美托咪定更適合用于心臟瓣膜術(shù)后鎮(zhèn)靜。
[Abstract]:Objective to compare the sedation effect and hemodynamics of dexmetomidine and propofol in patients with mechanical ventilation after cardiac valve operation. Methods Sixty patients with mechanical ventilation after cardiac valve operation were randomly divided into two groups: dexmetomidine group (group D, n = 30) and propofol group (group P, n = 30) who were given dexmetomidine 0.2g / (kg h) sufentanil 0.15 渭 g / (kg h) group and propofol 1.23.0 mg/ (kg h) sufentanil 0.15 渭 g / (kg h). The bispectral index (BIS) of EEG was defined as the sedative target according to the Richmond restlessness sedative score (RASS)-2 ~ (-3). The hemodynamic parameters were measured before operation (T _ 1), 2 h after cardiopulmonary bypass (CPB) (T _ s _ 2), 4 h (T _ s _ 3) and 12 h (T _ 4) after operation. BIS scores, mean arterial pressure (map), bradycardia, restlessness or delirium were compared between the two groups. Results there was no significant difference in BIS and Rass score between the two groups after sedation (P0.05). There was a significant difference in hemodynamic changes between the two groups after sedation. Map in group P was lower than that in group D at T2 time point (P0.05), and cardiac index (CI) in group D was higher than that in group P at the time of T3 and T 4 (P0.05P 0.01). The arterial blood lactate content in group P was significantly higher than that in group D at the time point of T _ 2 and T _ 3C _ 4 (P0.05, P0.01). There was no significant difference in systemic vascular resistance index (SVRI), stroke output (SV), right ventricular ejection fraction (RVEF) and mixed venous oxygen saturation (SvO2) between the two groups (P0.05). There was no significant difference in the dosage of vasoactive drugs between the two groups (P0.05). There was no significant difference in the incidence of bradycardia between the two groups (P0.05). The incidence of restlessness and delirium in group D was lower than that in group P (P0.05). Conclusion the sedation effect was better in both groups. Dexmetomidine has little effect on hemodynamics, and postoperative sedation can reduce the incidence of restlessness or delirium. Dexmetomidine is more suitable for sedation after cardiac valve surgery.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)征醫(yī)院胸心外科;
【分類號(hào)】：R654.2

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