Abstract：【Objective】To study the effects of different doses of dexmedetomidine on sedation and analgesia and heart rate variability of ICU patients during non-mechanical ventilation. 【Methods】Sixty-eight patients with non-mechanical ventilation admitted to ICU in our hospital from January 2018 to January 2019 were divided into high-dose group and low-dose group by random number table, 34 cases in each group. Both groups were given ICU routine treatment. The high-dose group was given the initial dose of dexmedetomidine 1.0 μg/(kg?h) on the basis of routine treatment, while the low-dose group was given the initial dose of dexmedetomidine 0.6 μg/(kg?h) on the basis of routine treatment. At the end of the treatment, the clinical related indicators such as the target score of RASS, the dosage of fentanyl, norepinephrine, propofol and the length of stay in ICU were compared between the two groups including the RASS score and CPOT score within 72 hours between the two groups; the adverse reactions such as delirium, bradycardia and hypotension between the two groups; the indicators of variability of heart rates such as low frequency power (LF) and high frequency power (HF) between the two groups.【Results】There were no significant differences in RASS score (-2~+1) time, CPOT score within 72 hours, propofol dosage, ICU hospitalization days, time of shallow sedation and delirium incidence between the two groups (P>0.05). The dosage of fentanyl, duration of deep sedation and HF value in the high dose group were significantly lower than those in the low dose group, while the dosage of norepinephrine, incidence of hypotension, bradycardia and LF value in the high dose group were significantly higher than those in the low dose group (P<0.05).【Conclusion】 The initial dose of 0.6 ug/Kg/h dexmedetomidine is more conducive to sedation of non-mechanical ventilation patients in ICU, with lower incidence of adverse reactions and lower heart variability rate.
杨岭, 袁月, 郑玉君. 不同剂量右美托咪定对ICU非机械通气患者镇静以及心率变异性的影响[J]. 医学临床研究, 2019, 36(5): 858-862.
YANG Ling, YUAN Yue, ZHENG Yu-jun. Effects of Different Doses of Dexmedetomidine on Sedation and Heart Rate Variability in ICU Patients without Mechanical Ventilation. JOURNAL OF CLINICAL RESEARCH, 2019, 36(5): 858-862.
[1] Caumo W,Schmidt AP,Schneider CN,et al. Risk factors for postoperative anxiety in adults[J]. Anesthesia,2001,56:720-728. [2] Novaes MA,Knobel E,Bork AM,et al. Stress in ICU: Perception of the patient relatives and health care team [J]. Intensive Care Med,1999,25:1421-1426. [3] Sanders RD,Hussell T,Maze M.Sedation and immunomodulatin[J].Anesthesiol Clin,2011,29(4):687-706. [4] Ho KM.Is dexmedetomidine an ideal sedative agent for neurosurgical patients[J].Anaesth Intensive Care,2012,40(6):927-928. [5] 中华医学会重症医学分会.中国成人 ICU 镇痛和镇静治疗指南[J].中华重症医学电子杂志, 2018,4(2):90-113. [6] Devlin JW.The pharmacology of oversedation in mechanically ventilated adults[J].Curr Opin Crit Care,2008,14(5):403-407. [7] Ely EW,Truman B,Shintani A,et al. Monitoring sedation status over time in ICU patients:reliability and validity of the Richmond Agitation-Sedation Scale(RASS)[J].JAMA,2003,289(22):2983-2991. [8] Sackey PV,Radell PJ,Granath F,et al.Bispectral index as a Predietor of Sedation depth during isoflurane or midazolam sedation in ICU Patients[J].Anaesth Intensive Care,2007,35(6):348-356. [9] Pichot C, Ghignone M, Quintin L.Dexmedetomidine and clonidine: From second to first-line sedative agents in the critical care setting[J]. Intensive Care Med,2012,27(7):219-237. [10] Hall JE,Uhrich TD, Ebert TJ. Sedative, analgesic and cognitive effects of clonidine infusions in humans[J].Br J Anaesth,2001,86(9):5-11. [11] Hall JE,Uhrich TD,Barney JA,et al.Sedative,amnestic,and analgesic properties of small-dose dexmedetomidine infusions[J].Anesth Analg,2000,90(3): 699-705. [12] Chrysostomoucs Constantions,Chmitt CG.Dexmedetomidine:sedation analgesia and beyond [J].Expert Opin Drug Metab Toxicol,2004,43(7):620-626. [13] Arain SR,Ruehlow RM, Uhrich TD,et al.The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery[J].Aneath Analg,2004,98(14):153-158. [14] 孙琳婧,于建飞,杨拥军,等.不同气腹压力对老年患者后腹腔镜手术应激反应的影响[J].临床麻醉学杂志,2017,33(3):298-300. [15] 徐斐,敖虎山.盐酸右美托咪定的临床应用[J].中国循环杂志,2014,30(4):401-403. [16] Zeng Q M,Lei F,Gao Z Y,et al. Case-matched study of short-term effects of 3D vs 2D laparoscopic radical resection of rectal cancer [J]. World J Surg Oncol,2017,15(1):178-187. [17] 魏芳芳,卢炳益.右美托咪定对腹腔镜直肠癌根治术患者的心肌保护作用研究[J].现代中西医结合杂志,2017,26(11):1235-1237. [18] Tarvainen MP,Georgiadis S,Laitio T,et al.Heart rate variability dynamics during low-dose propofol and dexmedetomidine anesthesia[J].Ann Biomed Engineering,2012,40(8):1802-1813. [19] 韩永正,许川雅,续飞 ,等.右美托咪定对腹腔镜胆囊切除术心率变异性的影响[J].临床麻醉学杂志,2014,30(3):225-227. [20] Qi YY,Yao XY, Zhang BB, et al. Comparison of recovery effect for sufentanil and remifentanil anesthesia with TCI in laparoscopic radical resection during colorectal cancer [J]. Oncol Lett,2016,11(5):3361-3365. [21] Tobias JD.Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiolog[J].Pediatr Crit Care Med,2007,8(2):115-131.
2019, Vol. 36 
