不同负荷剂量右美托咪定对危重症患者心率和血压的影响

发布时间：2019-01-24 20:13

【摘要】：目的右美托咪定是一种高选择性α2肾上腺素能受体激动剂,其最常见的不良反应有低血压、恶心、心动过缓。本实验拟比较不同负荷剂量右美托咪定在重症监护室(ICU)应用时镇静效果及对危重病患者心率(HR)、血压(BP)、呼吸的影响,从而为临床应用提供参考依据。方法选择2013.05—2013.11月和2015.01—2015.03月入住我院ICU病房需要镇静镇痛的患者作为研究对象,同时排除BP200mmhg,HR60次/分,休克未纠正的患者。将其随机分为3组(A、B、C组),首先给予患者不同负荷剂量右美托咪定静脉泵注10min,然后继续予微量泵持续泵入维持剂量右美托咪定。同时记录患者泵注前,泵注后2min、4min、6min、8min、10min、60min、120min、180min、240min各时刻的Ramsay评分、心率、收缩压(SBP)、舒张压(DBP)、呼吸频率(BR)、Sp O2。结果静脉泵注右美托咪定后,A组、B组较C组更快达到镇静状态(P0.05)。三组患者HR、SBP、DBP均呈下降趋势,A组、B组在泵注8min—60min时HR下降较C组明显(P0.05),A组在泵注10min时SBP下降较B组和C组明显(P0.05),泵注维持剂量右美托咪定后三组SBP下降趋势无明显差异(P0.05)。结论右美托咪定在ICU镇静镇痛应用中,维持剂量(0.4μg/kg·h)可以达到理想镇静目标,如临床需快速镇静,推荐负荷剂量为0.5ug/kg·10min。对于老年患者、AECOPD及贫血患者在使用右美托咪定时应尽量避免使用高负荷量快速泵入,必要时可以考虑联合用药。
[Abstract]:Objective dexmetidine is a highly selective 伪 2 adrenergic receptor agonist. The most common adverse effects are hypotension, nausea and bradycardia. The purpose of this study was to compare the sedation effect of dexmetomidine with different load doses in (ICU) of intensive care unit (ICU) and the effect of dexmetidine on (BP), respiration of heart rate (HR), in critically ill patients so as to provide reference for clinical application. Methods the patients who needed sedation and analgesia in ICU ward of our hospital from May to November and from January to March 2015.were selected as the study objects, and those patients who had not been corrected for shock were excluded from BP200mmhg,HR60 times / minutes at the same time. The patients were randomly divided into three groups (group A, B, C). The patients were treated with dexmetomidine for 10 min at different loading doses, and then continued to be continuously pumped into the maintenance dose of dexmetomidine by micropump for 10 min. At the same time, the Ramsay scores, heart rate and (DBP), respiratory rate of (SBP), diastolic pressure (DBP),) were recorded at 2 min, 4 min, 6 min, 8 min, 10 min, 60 min, 120 min, 180 min and 240 min, respectively. Results after intravenous injection of dexmetidine, group A and group B reached sedation faster than group C (P0.05). The HR,SBP,DBP of group A and group B was significantly lower than that of group C (P0.05). The SBP of group), A was significantly lower than that of group B and group C (P0.05), and that of group B was significantly lower than that of group B (P0.05), and that of group B was significantly lower than that of group C (P0.05). There was no significant difference in the decreasing trend of SBP among the three groups after the maintenance dose of dexmetidine (P0.05). Conclusion the maintenance dose (0.4 渭 g/kg / h) of dexmetidine for sedation and analgesia of ICU can achieve the ideal sedation goal. If rapid sedation is needed in clinic, the recommended loading dose is 0.5ug/kg for 10 minutes. For elderly patients, AECOPD and anemia patients should avoid the use of high load and fast pump when using dexmetomide, and may consider combined use if necessary.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614.2

【相似文献】