右美托咪定与丙泊酚对心脏瓣膜术后机械通气患者镇静效果及血流动力学的影响

发布时间：2018-07-04 08:31

本文选题：右美托咪定 + 丙泊酚　；参考：《第二军医大学学报》2017年05期

【摘要】：目的比较右美托咪定与丙泊酚对心脏瓣膜术后机械通气患者的镇静效果及血流动力学的影响。方法选取60例心脏瓣膜术后机械通气患者,随机分为右美托咪定组(D组)30例和丙泊酚组(P组)30例,D组给予右美托咪定0.2~0.7μg/(kg·h)+舒芬太尼0.15μg/(kg·h),P组给予丙泊酚1.2~3.0 mg/(kg·h)+舒芬太尼0.15μg/(kg·h)。以脑电双频指数(BIS)值为70~85、Richmond躁动镇静评分(RASS)-2~-3分为镇静目标。分别于术前(T_1)、心肺转流(CPB)结束后2 h(T_2)、术后4 h(T_3)和术后12 h(T_4)测定患者血流动力学相关指标。比较两组患者各观察时间点的BIS值、RASS评分以及平均动脉压(MAP)下降、心动过缓、躁动或谵妄等不良反应发生率。结果两组患者镇静后的BIS值与RASS评分差异无统计学意义(P0.05)。两组患者镇静后血流动力学变化存在差异,MAP有不同程度的下降,在T_2时间点,P组的MAP小于D组(P0.05);在T_3、T_4时间点,D组心指数(CI)高于P组(P0.05,P0.01)。在T_2、T_3、T_4时间点,P组的动脉血乳酸含量较D组升高明显(P0.05,P0.01)。两组间T_1~T_4各时点的全身血管阻力指数(SVRI)、每搏输出量(SV)、右心室射血分数(RVEF)、混合静脉血氧饱和度(Sv O2)差异无统计学意义(P0.05)。两组各血管活性药物用量差异无统计学意义(P0.05)。两组患者术后MAP下降、心动过缓发生率差异无统计学意义(P0.05),D组镇静过程中躁动及谵妄发生率低于P组(P0.05)。结论两组患者均可取得较好的镇静效果。右美托咪定对血流动力学影响较小,且其用于术后镇静可降低躁动或谵妄的发生率。右美托咪定更适合用于心脏瓣膜术后镇静。
[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.
【作者单位】：第二军医大学长征医院胸心外科;
【分类号】：R654.2

【相似文献】