Clinical effect of dexmedetomidine hydrochloride injection combined with butorphanol conventional therapy on sedation of intensive care unit patients / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the effect of dexmedetomidine combined with butorphanol conventional therapy on sustaining sedation of intensive care unit (ICU) patients.Methods Sixty critically ill patients in Binzhou Central Hospital from June to September in 2014 were randomly divided into experimental group and control group, 30 cases in each group. In the control group, 0.8 mg/L dexmedetomidine hydrochloride injection (400μg with addition of 46 mL normal saline to form 50 mL solution) was intravenously infused continuously at a speed of 0.4μg·kg-1·h-1 by a micro-pump to induce analgesia and sedation; while in the experimental group, dexmedetomidine combined with 200 mg/L butorphanol (10 mg plus 40 mL normal saline to form 50 mL solution) was given for intravenous infusion by a micro-pump with a speed of 0.01 mg·kg-1·h-1 to maintain analgesia and sedation for 48 hours whose required Ramsay score in both groups was 3 - 5. Before and after treatment, the changes of heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and the pulse oxygen saturation (SpO2) of both groups were observed. The dosage of dexmedetomidine used for maintenance of required analgesia and sedation and FPS (facial expression) grading and Ramsay score were compared respectively between the two groups, and the clinical efficacy of the two groups were evaluated.Results After treatment, the HR, MAP, RR in both groups were significantly lower, and PaO2 and SpO2 were significantly higher than those before treatment, and the degrees of improvement in the above indexes of the experiment group were superior to those of the control group [HR (bpm) 84.58±12.43 vs. 118.62±14.21, MAP (mmHg, 1 mmHg = 0.133 kPa) 82.35±12.12 vs. 92.35±12.32, RR (times/min) 25.42±3.98 vs. 32.87±5.12, PaO2 (mmHg) 95.21±10.55 vs. 75.18±8.57, SpO2 0.981 4±0.102 8 vs. 0.954 7±0.093 8, allP < 0.05]. The total therapeutic effect in experiment group was significantly higher than that in control group [93.3% (28/30) vs. 76.7% (22/30),P < 0.05]. The dexmedetomidine dosage used in the experiment group was much less than that in the control group (μg/d 412.12±23.18 vs. 520.05±15.68,P < 0.05). The FPS score in the experiment group was obviously lower than that in the control group (1.48±0.16 vs. 2.52±0.74,P < 0.05).Conclusion In comparison, to achieve sustained and required analgesic and sedative effect for ICU patients by combined use of dexmedetomidine and butorphanol, the dosage of dexmedetomidine used is less than dexmedetomidine applied alone, in addition, the combined use can achieve better Ramsay grading, steady blood pressure and excellent effect.