目的 探讨右美托咪定对舌癌术后机械通气患者的镇静效果。方法 选取2015-06至2017-06收治的80例舌癌术后行机械通气的患者,随机分为对照组(42例)和治疗组(38例)。对照组予以咪达唑仑镇静治疗,治疗组予以右美托咪定镇静治疗。比较两组患者机械通气时间、气管导管带管时间、ICU住院时间等指标;比较两组患者术后0、4、8 h的心率(HR)、平均动脉压(MAP)、血氧饱和度(SaO2)和动脉氧分压PaO2等血流动力学指标及血气分析指标;比较两组术后4、8、12 h的RASS评分,以及机械通气治疗期间的不良反应发生情况。结果 手术后,治疗组机械通气时间、气管导管带管时间、ICU停留时间显著短于对照组(P<0.05或P<0.01)。术后4、8 h,两组HR、MAP、PaO2水平均较同组0 h时有所改善,且治疗组4 h的HR、MAP显著优于对照组(P<0.05)。术后8、12 h,两组RASS评分均较术后4 h显著升高,治疗组术后8、12 h的RASS评分均显著高于对照组(P<0.05)。治疗组不良反应发生率为23.7%,对照组为26.2%。结论 将右美托咪定应用于舌癌术后患者维持镇静效果显著。
Abstract
Objective To investigate the effect of dexmedetomidine on mechanical ventilation patients after tongue cancer surgery.Methods Eighty mechanical ventilation patients after tongue cancer surgery were randomly divided into control group (n=42) and treatment group (n=38). The control group was treated with midazolam for sedation, while the treatment group was treated with dexmedetomidine. The duration of mechanical ventilation, indwelling time of the endotracheal tube and ICU stay in the hospital were compared between the two groups. The heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation(SaO2), arterial oxygen pressure [p (O2)] and hemodynamic parameters at 0, 4, 8 and 12 h after operation were compared. The RASS scores at 4, 8 and 12 h after operation and adverse reactions during mechanical ventilation were compared between the two groups.Results After operation, the treatment group had a significantly shorter time of mechanical ventilation, indwelling time of the endotracheal tube and the ICU stay than the control group (P<0.05 or P<0.01).At 4 and 8 h, HR, MAP and p (O2) of the two groups were all improved than at 0 h, especially in the treatment group at 4 h (P<0.05). RASS scores in the two groups were significantly higher at 8, 12 h after operation than that at 4 h after operation, and those of the treatment group were significantly higher at 8, 12 h than in the control group (P<0.05). The incidence of adverse reactions was 23.7% in the treatment group, and 26.2% in the control group. The incidence of delirium in the treatment group was significantly lower than that in the control group (P<0.05). Conclusions Dexmedetomidine has significant effect on postoperative sedation for patients after tongue cancer surgery.
关键词
右美托咪定 /
咪达唑仑 /
镇静 /
机械通气 /
舌癌 /
谵妄
Key words
dexmedetomidine /
midazolam /
sedation /
mechanical ventilation /
tongue cancer /
delirium
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基金
湖南省卫生计生委科研计划课题横向项目(B2017189)
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