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目的探讨不同镇静深度对严重多发伤患者血流动力学的影响。方法纳入我科2014年11月至2016年2月收治的严重多发伤患者60例,随机分为A组和B组,每组30例。在脉搏指示连续心排血量(Pi CCO)监测技术监测下,以不同剂量右美托咪啶使A组[初始剂量:1μg/(kg·h)]患者维持深度镇静,B组[初始剂量:0.5μg/(kg·h)]患者维持轻度镇静,之后均以0.2μg/(kg·h)剂量维持;两组静脉输注舒芬太尼镇痛剂量(5.0μg/kg)及方案一致。观察两组患者镇静、镇痛前(T0)及后6 h(T_1)、12 h(T_2)、24 h(T_3)、48 h(T_4)、72 h(T_5)的心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、氧合指数(PaO_2/FiO_2)、左心室收缩力指数(d Pmax),以及镇静、镇痛相关不良反应。结果两组患者HR在镇静、镇痛后均逐渐下降,其中B组患者T_2、T_3时间点的HR显著低于A组(P<0.05);两组患者CVP、PaO_2/FiO_2、d Pmax在镇静、静痛后逐渐上升,其中B组患者的CVP(除T_1)显著低于A组(P<0.05),PaO_2/FiO_2和d Pmax(除T_1)显著高于A组(P<0.05);A组患者的MAP在T_1、T_2、T_4、T_5时间点较T_0降低(P<0.05);B组患者的MAP在T_1较T_0降低(P<0.05),其他时间点与T0相比差异无统计学意义,其中B组患者在T_2、T_4、T_5时间点的MAP显著高于A组(P<0.05)。A组患者不良反应发生率(16.7%)高于B组(6.7%,P<0.05)。结论在严重多发伤患者的镇痛、镇静中,适当降低镇静深度,能避免严重多发伤患者血流动力学的剧烈波动,同时可减少镇静药物的用量及其相关不良反应。
Objective To investigate the effects of different sedation depth on hemodynamics in patients with severe multiple trauma. Methods Sixty patients with severe multiple trauma who were admitted to our department from November 2014 to February 2016 were randomly divided into group A and group B, with 30 cases in each group. Patients in group A [initial dose: 1 μg / (kg · h)] were maintained sedated with different doses of dexmedetomidine, monitored by the PiCCO monitoring technique. Group B [initial dose : 0.5μg / (kg · h)] patients maintained mild sedation, and then were 0.2μg / (kg · h) dose maintenance; two intravenous sufentanil analgesic dose (5.0μg / kg) and the program Consistent. The heart rate (HR) of the two groups were observed before sedation, before T 0 and after 6 h T 1, 12 h T 2, T 3, 48 h (T 4) and 72 h (T 5) CVP, MAP, PaO 2 / FiO 2 and d Pmax, as well as sedation and analgesia-related adverse reactions. Results The HR of both groups decreased gradually after sedation and analgesia. HR of group B at T 2 and T 3 was significantly lower than that of group A (P <0.05); CVP, PaO 2 / FiO 2 and d P max were lower in both groups (P <0.05), and PaO_2 / FiO_2 and d Pmax (except T_1) in group B were significantly higher than those in group A (P <0.05); A MAP of T group was lower than that of T 0 at T 1, T 2, T 4 and T 5 time points (P <0.05); MAP of T group was lower than T 0 at T 1 (P <0.05), but there was no significant difference at T 0 Significance, MAP in group B at T 2, T 4 and T 5 time points was significantly higher than that in group A (P <0.05). The incidence of adverse reactions in group A (16.7%) was higher than that in group B (6.7%, P <0.05). Conclusions In the severe trauma patients’ analgesia and sedation, the appropriate reduction of sedation depth can avoid the severe fluctuation of hemodynamics in patients with severe multiple trauma and reduce the dosage of sedative drugs and its related adverse reactions.