［40］。更多的研究认为，右美托咪定应用于术后和危重患者可以降低谵妄发生率［9，14，41］。

5 结语

右美托咪定对脓毒症机械通气患者的死亡率和机械通气时间无明显影响；更多的证据显示，右美托咪定可以作为一个优化选择应用于机械通气危重患者效果明显，减少了机械通气时间、ICU滞留时间，但同时关注心动过缓和低血压风险。如果可以减少机械通气时间和少用镇痛药，右美托咪定带来的心动过缓和低血压风险不是一个需要特别关注的问题。

［1］ Barr J,Fraser GL,Puntillo K,et al．American College of Critical Care Medicine． Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit． Crit Care Med,2013,41(1)：263-306．

［2］ Spina SP,Ensom MH．Clinical pharmacokinetic monitoring of midazolam in critically ill patients． Pharmacotherapy,2007, 27：389-398．

［3］ 李雄娟,黄焕森,陈海铭,等．右美托咪定鞘内注射对大鼠急性疼痛行为及脊髓GIRK2表达的影响［J］．广东医学,2013,34(12)：1816-1818．

［4］ 伍志坤,黄焕森,刘洁,等．右美托咪定对大鼠急性疼痛行为及大脑皮质GIRK1表达的影响［J］．广东医学,2015,36(14)：2148-2151．

［5］ Tan JA,Ho KM．Use of dexmedetomidine as a sedative and analgesic agent in critica-lly ill adult patients： a meta-analysis． Intensive Care Med,2010,36：926-939．

［6］ Riker RR,Shehabi Y,Bokesch PM,et al．Dexmedetomidine vs midazolam for sedation of critically ill patients： a randomized trial．JAMA,2009,301：489-499．

［7］ Eser O,Fidan H,Sahin O,et al．The influence of dexmedetomidine on ischemic rat hippocampus．Brain Res,2008,1218：250-256．

［8］ Isguzar O,Baris S,Bozkurt A,et al．Evaluation of antinociceptive and neurotoxic effects of intrathecal dexmedetomidine in rats．Balkan Med J,2012,29(4)：354-357．

［9］ Hoy SM,Keating GM．Dexmedetomidine： a review of its use for sedation in Mechan-ically ventilated patients in an intensive care setting and for procedural sedation．Drugs,2011,71(11)：1481-1501．

［10］ Keating GM,Hoy SM,Lyseng-Williamson KA．Dexmedetomidine：a guide to its use for sedation in the US．Clin Drug Investig, 2012,32(8)：561-567．

［11］ Fraser GL,Devlin JW,Worby CP,et al．Benzodiazepine versus nonbenzodiazepine -based sedation for mechanically ventilated,critically ill adults：a systematic review and meta-analysis of randomized trials．Crit Care Med,2013,41(9 Suppl 1)：S30-38．

［12］ Esmaoglu A, Ulgey A, Akin A, et al． Comparison between dexmedetomidine and midazolam for sedation of eclampsia patients in the intensive care unit．J Crit Care,2009,24：551-555．

［13］ Riker RR, Shehabi Y,Bokesch PM,et al．SEDCOM(Safety and Efficacy of dexmede-tomidine Compared With Midazolam)Study Group．Dexmedetomidine vs midazolam for sedation of critically ill patients： a randomized trial．JAMA,2009,301(5)：489-499．

［14］ MacLaren R, Preslaski CR, Mueller SW, et al． A randomized,double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation： patient recall of their experiences and short-term psychological outcomes．J Intensive Care Med,2015,30(3)：167-175．

［15］ Lu X,Li J,Li T,et al．Clinical study of midazolamsequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit．Chin J Traumatol,2016,19(2)：94-96．

［16］ Gao Y,Kang K,Liu H,et al．Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients： A retrospective study．Medicine(Baltimore),2017,96(25)：e7090．

［17］ Dasta JF,Kane-Gill SL,Pencina M,et al．A cost-minimization analysis of dexmedet-omidine compared with midazolam for long-term sedation in the intensive care unit．Crit Care Med,2010,38(2)：497-503．

［18］ Turunen H,Jakob SM,Ruokonen E,et al．Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care： an economic evaluation．Crit Care,2015,19：67．

［19］ Pandharipande PP,Pun BT,Herr DL,et al．Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients： the MENDS randomized controlled trial． JAMA,2007,298：2644-2653．

［20］ Mogahd MM,Mahran MS,Elbaradi GF．Safety and efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations for sedation in patients after coronary artery bypass graft surgery．Ann Card Anaesth,2017,20(2)：182-187．

［21］ Ruokonen E,Parviainen I,Jakob SM,et al．"Dexmedetomidine for Continuous Sedation"Investigators．Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation．Intensive Care Med,2009,35(2)：282-290．

［22］ Jiang YK,Wang S,Lam TS,et al．Prevalence of Delirium and Coma In Mechanically Ventilated Patients Sedated With Dexmedetomidine or Propofol．P T,2016,41(7)：442-445．

文章来源：《机械管理开发》 网址: http://www.jxglkf.cn/qikandaodu/2021/0722/1577.html

上一篇：事业单位人力资源管理存在的问题及改革措施
下一篇：翻转课堂在专业课程教学中的应用