切换至 "中华医学电子期刊资源库"

中华卫生应急电子杂志 ›› 2022, Vol. 08 ›› Issue (06) : 331 -334. doi: 10.3877/cma.j.issn.2095-9133.2022.06.003

论著

院前右美托咪啶与丙泊酚对需要机械通气的成人危重症患者镇静效果的比较
潘鑫1, 王华2,(), 王忻1, 顾慧1, 王超1   
  1. 1. 212003 江苏镇江,镇江市急救中心急救科;212013 江苏镇江,江苏大学灾难与急救医学系
    2. 212001 江苏镇江,江苏大学附属医院疼痛科
  • 收稿日期:2022-11-05 出版日期:2022-12-18
  • 通信作者: 王华
  • 基金资助:
    2021年度镇江市社会发展指导性科技计划项目(FZ2021092); 2021年度"金山英才"高层次领军人才培养计划(第六期"169工程")科研资助项目(镇人才办[2021]19号文件)

Comparison of the sedative effects of dexmedetomidine and propofol on critically ill adult patients requiring mechanical ventilation in the prehospital setting

Xin Pan1, Hua Wang2,(), Xin Wang1, Hui Gu1, Chao Wang1   

  1. 1. Zhenjiang Emergency Center Emergency Department, Zhenjiang 212003, China; Department of Disaster and Emergency Medicine, Jiangsu University, Zhenjiang 212013, China
    2. Department of Pain, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
  • Received:2022-11-05 Published:2022-12-18
  • Corresponding author: Hua Wang
引用本文:

潘鑫, 王华, 王忻, 顾慧, 王超. 院前右美托咪啶与丙泊酚对需要机械通气的成人危重症患者镇静效果的比较[J]. 中华卫生应急电子杂志, 2022, 08(06): 331-334.

Xin Pan, Hua Wang, Xin Wang, Hui Gu, Chao Wang. Comparison of the sedative effects of dexmedetomidine and propofol on critically ill adult patients requiring mechanical ventilation in the prehospital setting[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2022, 08(06): 331-334.

目的

本研究旨在比较院前环境下右美托咪啶和丙泊酚在机械通气成人危重症患者中的镇静效果。评估两种药物对患者血流动力学参数影响,观察脑电双频指数(BIS)与常用主观量表Ramsay镇静评分(RSS)的相关性。

方法

前瞻性随机研究60例院前环境下需要镇静和机械通气的血流动力学稳定患者,平均分为两组,A组给予右美托咪啶负荷剂量(1 μg/kg) 10 min以上,随后给予0.5 μg·kg-1·h-1 (0.2~0.7 μg·kg-1·h-1)维持输注。B组给予丙泊酚负荷剂量(1 mg/kg)5 min以上,随后给予2 mg·kg-1·h-1 (1~3 mg·kg-1·h-1)维持输注。所有患者在研究用药前均接受芬太尼1 μg/kg治疗,监测患者在急救现场及入院时血流动力学参数,及其镇静水平(使用RSS和BIS),以RSS水平4分或5分为镇静目标。将Ramsay得分与BIS平均值进行比较。

结果

研究显示右美托咪啶组镇静时心率明显降低,而丙泊酚组镇静时平均动脉压(MAP)下降。Ramsay评分与BIS值之间存在较好的相关性。

结论

右美托咪啶可降低心率,丙泊酚可瞬时影响平均动脉压。两种药物都能达到充分的镇静作用,Ramsay评分与BIS值之间存在较好的相关性,支持BIS监测在评估院前急救气管插管重症患者镇静监测的适用性。

Objective

To compare the sedative effects of dexmedetomidine and propofol in critically ill adults undergoing mechanical ventilation in the prehospital setting. The effects of two drugs on hemodynamic parameters were evaluated, and the correlation between bispectral index(BIS)and Ramsay sedation score(RSS)was observed.

Methods

Sixty hemodynamically stable patients requiring sedation and mechanical ventilation in the prehospital setting were prospectively randomized into two groups. Group A received a loading dose of dexmedetomidine(1 μg/kg)for more than 10 min, followed by a maintenance infusion of 0.5 μg·kg-1·h-1 (0.2~0.7 μg·kg-1·h-1). Group B was given a loading dose of propofol(1 mg/kg)for more than 5 min, followed by a maintenance infusion of 2 mg·kg-1·h-1(1~3 mg·kg-1·h-1). All patients were treated with fentanyl 1 μg/kg before the study drug. Hemodynamic parameters were monitored at the emergency scene and on admission, and their sedation level(using RSS and BIS) was monitored. Ramsay scores were compared with BIS mean values.

Results

The dexmedetomidine group had a significant decrease in heart rate during sedation, while the propofol group had a decrease in mean arterial pressure(MAP)during sedation. There was a good correlation between Ramsay score and BIS value.

Conclusions

Dexmedetomidine can reduce heart rate and propofol can transiently affect mean arterial pressure. Both drugs are able to achieve adequate sedation, and there is a good correlation between Ramsay scores and BIS values. BIS surveillance is supported in assessing the applicability of sedation monitoring in prehospital emergency tracheal intubated patients with severe disease.

表1 抢救现场和入院时的血流动力学参数
图1 两组RSS评分的BIS均值描述注:BIS为脑电双频指数
图2 两组RSS与BIS平均值的相关性。注:每个时点两组r值均≥0.8,P<0.01,均具有相关性
1
Manasco AT, Stephens RJ, Yaeger LH,et al.Ketamine sedation in mechanically ventilated patients:a systematic review and meta-analysis[J].J Crit Care2020(56):80-88.
2
Tse AHW, Ling L, Lee A,et al.Altered pharmacokinetics in prolonged infusions of sedatives and analgesics among adult critically ill patients:a systematic review[J].Clin Ther2018,40(9):1598-1615.
3
Keating GM.Dexmedetomidine:a review of its use for sedation in the intensive care setting[J].Drugs2015,75(10):1119-1130.
4
Shehabi Y, Howe BD, Bellomo R,et al.Early sedation with dexmedetomidine in critically ill patients[J].N Engl J Med2019,380(26):2506-2517.
5
Hughes CG, McGrane S, Pandharipande PP.Sedation in the intensive care setting[J].Clin Pharmacol2012(4):53-63.
6
Choi HR, Song IA.Review of remimazolam and sedatives in the intensive care unit[J].Acute Crit Care2022,37(2):151-158.
7
Jacobi J, Fraser GL, Coursin DB,et al.Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult[J].Crit Care Med2002,30(1):119-141.
8
Gorman T, Bernard F, Marquis F,et al.Best evidence in critical care medicine: daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation[J].Can J Anaesth2004,51(5):492-493.
9
Adams R, Brown GT, Davidson M,et al.Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients:a systematic review[J].Br J Anaesth2013,111(5):703-710.
10
Srivastava VK, Agrawal S, Kumar S,et al.Comparison of dexmedetomidine,propofol and midazolam for short-term sedation in postoperatively mechanically ventilated neurosurgical patients[J].J Clin Diagn Res2014,8(9):GC04-GC07.
11
Shah PN, Dongre V, Patil V,et al.Comparison of post-operative ICU sedation between dexmedetomidine and propofol in Indian population[J].Indian J Crit Care Med2014,18(5):291-296.
12
Gertler R, Brown HC, Mitchell DH,et al.Dexmedetomidine:a novel sedative-analgesic agent[J].Proc (Bayl Univ Med Cent)2001,4(1):13-21.
13
Weinbroum AA, Halpern P, Rudick V,et al.Midazolam versus propofol for long-term sedation in the ICU:a randomized prospective comparison[J].Intensive Care Med1997,23(12):1258-1263.
14
Ricker RR.Comparison of dexmedetomidine vs midazolam for sedation of critically ill patients[J].JAMA2009,301(5):489-499.
15
Ickeringill M, Shehabi Y, Adamson H,et al.Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy[J].Anaesth Intensive Care2004,32(6):741-745.
16
Shetty RM, Bellini A, Wijayatilake DS,et al.BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization[J].Cochrane Database Syst Rev2018,2(2):CD011240.
[1] 张治明, 肖裔兴, 秦苑, 赵昀, 史艳华. 髋关节置换术后右美托咪定增强罗哌卡因的镇痛效果[J]. 中华关节外科杂志(电子版), 2021, 15(06): 743-747.
[2] 周顺, 赵素侠, 时静静, 吴双双, 吴圆圆, 李金山. 丙泊酚-舒芬太尼复合七氟烷吸入对小儿腹腔镜疝囊高位结扎术的麻醉效果及安全性[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 603-607.
[3] 曾凯旋, 何国安. 丙泊酚与七氟烷在老年腹股沟疝腹腔镜手术的应用效果及安全性比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 316-321.
[4] 李鑫, 高元丽, 经俊, 陆星, 马臻. 纳布啡复合丙泊酚在腹腔镜经腹腹膜前腹股沟疝修补术中的应用研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(02): 191-195.
[5] 张宏江, 刘雪莲, 郑立. 阿芬太尼联合丙泊酚麻醉在小儿腹腔镜疝囊高位结扎术的效果观察[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 711-715.
[6] 赵璐, 侯俊德, 陈永学, 王晓微, 陈士欢, 刘盼盼. 瑞芬太尼复合丙泊酚在腹股沟斜疝患儿腹腔镜手术麻醉中的镇痛效果[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(04): 429-431.
[7] 丁美平, 包义勇, 韦友琴, 吴鼎, 吴志东. 瑞芬太尼、丙泊酚复合七氟醚在小儿腹股沟斜疝腹腔镜手术中的麻醉效果[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(04): 435-438.
[8] 陈静, 张春明, 周斌, 吴明明. 甲苯磺酸瑞马唑仑联合瑞芬太尼全身麻醉对胸腔镜肺叶切除患者术后应激反应及血清PAF、γ干扰素的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 554-556.
[9] 王静, 李楠楠, 黄大海. 丙泊酚联合右美托咪定在肺炎患者支气管-肺泡灌洗术中的临床应用[J]. 中华肺部疾病杂志(电子版), 2022, 15(03): 406-409.
[10] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[11] 李青华, 靳晨彦, 王艳军, 庄禹童, 何江弘, 郭文治. 七氟醚与丙泊酚对慢性意识障碍患者全身麻醉期间脑电的影响[J]. 中华神经创伤外科电子杂志, 2023, 09(01): 12-18.
[12] 詹维强, 许明, 李梦蝶, 常林, 芦乙滨. 苯磺酸瑞马唑仑用于ICU机械通气患者镇静的有效性与安全性[J]. 中华重症医学电子杂志, 2022, 08(01): 16-22.
[13] 隋金玲, 张爱萍, 许旭东. 右美托咪定复合瑞芬太尼在内镜逆行胰胆管造影术老年患者中的麻醉效果[J]. 中华消化病与影像杂志(电子版), 2022, 12(06): 357-360.
[14] 史绿儿, 任奇, 沈杭霞. 右美托咪啶对老年患者心脏手术疗效影响的Meta分析[J]. 中华老年病研究电子杂志, 2023, 10(01): 34-40.
[15] 喇宏玲, 李育耕, 阿里木江·司马义, 徐桂萍, 苏涛. 右美托咪定复合舒芬太尼应用于肥胖患者无痛胃镜检查清醒镇静的效果[J]. 中华胃食管反流病电子杂志, 2023, 10(02): 77-81.
阅读次数
全文


摘要