右美托咪定与丙泊酚对外科危重症患者血流动力学影响的比较。
Comparison of dexmedetomidine versus propofol on hemodynamics in surgical critically ill patients.
作者信息
Chang Ya-Fei, Chao Anne, Shih Po-Yuan, Hsu Yen-Chun, Lee Chen-Tse, Tien Yu-Wen, Yeh Yu-Chang, Chen Lee-Wei
机构信息
Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
出版信息
J Surg Res. 2018 Aug;228:194-200. doi: 10.1016/j.jss.2018.03.040. Epub 2018 Apr 11.
BACKGROUND
Sedation with dexmedetomidine and propofol may cause hypotension or bradycardia. This study aimed to compare the effects of dexmedetomidine and propofol on hemodynamics and clinical outcomes in surgical intensive care unit (ICU) patients after major abdominal surgery.
MATERIALS AND METHODS
Enrolled patients were randomly allocated to the dexmedetomidine or propofol group. Cardiac index was measured using a continuous noninvasive cardiac output monitor on the basis of chest bioreactance. Heart rate, blood pressure, opioid requirement, urine output, delirium incidence, ICU length of stay, and total hospital length of stay were compared between the two groups. The incidences of bradycardia, hypotension, and severe low cardiac index were compared.
RESULTS
We enrolled 60 patients. Heart rate and mean arterial pressure were significantly lower in the dexmedetomidine group than in the propofol group. Cardiac index did not differ significantly between the two groups (dexmedetomidine group 3.1 L/min/m, [95% confidence interval {95% CI} 2.8-3.3] versus propofol group 3.2 L/min/m [95% CI 2.9-3.5], P = 0.578). The incidences of bradycardia, hypotension, and severe low cardiac index did not differ significantly between the two groups.
CONCLUSIONS
Cardiac index did not differ significantly between the dexmedetomidine and propofol groups in surgical ICU patients after major abdominal surgery.
背景
右美托咪定和丙泊酚镇静可能导致低血压或心动过缓。本研究旨在比较右美托咪定和丙泊酚对腹部大手术后外科重症监护病房（ICU）患者血流动力学及临床结局的影响。
材料与方法
将入选患者随机分为右美托咪定组或丙泊酚组。基于胸部生物电阻抗，使用连续无创心输出量监测仪测量心脏指数。比较两组患者的心率、血压、阿片类药物需求量、尿量、谵妄发生率、ICU住院时间及总住院时间。比较心动过缓、低血压及严重低心脏指数的发生率。
结果
我们纳入了60例患者。右美托咪定组的心率和平均动脉压显著低于丙泊酚组。两组间心脏指数无显著差异（右美托咪定组3.1L/min/m²，[95%置信区间{95%CI}2.8 - 3.3]；丙泊酚组3.2L/min/m² [95%CI 2.9 - 3.5]，P = 0.578）。两组间心动过缓、低血压及严重低心脏指数的发生率无显著差异。
结论
在腹部大手术后的外科ICU患者中，右美托咪定组和丙泊酚组的心脏指数无显著差异。
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