Q南方昔院右美托咪定在1CU中的應用南方醫院重癥醫學科陳仲清Q南方院lCU的患者鎮靜鎮痛不足的危害疼痛可導致機體應激睡眠不足、疲勞和定向力障礙導致心動過速、組織耗氧增加高凝狀態免疫抑制分解代謝增加是引起焦慮、躁動、精神障礙及痛苦記憶的主要原因之增加醫療意外的發生率、增加心血管并發癥的發生率、增加住院時間ManganoDT,etal:Ane南方普院5:9222Q南方院二、IωU中常用的鎮靜藥和鎮痛藥鎮靜藥彐鎮痛藥異丙酚嗎啡咪唑安定芬太尼安定舒芬太尼■氯羥安定瑞芬太尼Q南方院常用鎮痛藥物的不足之處呼吸抑制血壓下降胃腸蠕動減弱意識抑制延長機械通氣時間■引起幻覺、加重煩躁Q南方院理想的鎮靜狀態·保留各種保護性反射·患者有能力維持呼吸道通暢·對呼吸、循環影響小·生理刺激有正常反應,語言呼喚有反應有如“自然睡眠狀態”的鎮靜Q南方醬院JAMAVol.301No.5,February4,2009ANeweraforsedationinicupatientsHannahWunsch,MDICU患者鎮靜的新時代KEYWORDS:benzodiazepines,articalcare,deliriumexmederomidinghypnoticsandsedates,intensivecareunits,midazolam,outcomeassessment(healthPublishedonineFebruary2,2009(doi:10.1001/jama.2009.24)Criticallylpatientsfrequentlyrequireinvasivemonitorngandothersupportthatcaneadtoanxiety,agtaton,andpain.Useofsedationisessentialforthecomfortandsafetyofthesepatients.Optionsforsedationnthentensvecareunit(ICU)areinted,wthbenzodazepnesandpropofalthemostcommonchoices.2.3Inthepast,theseagentsweregenerallyusedkeeppatientsmotionlessandtoreducememoryoftheirexperienceintheICU.Howeverrecognitonthatheavysedationmayncreasemortallyandmorbidityhasledtoanewmodelinwhichtheemphasisisonmaxmzngthecomfortofthesepatientswhiletheyremaininteractive,ariented,andabletofolowinstructions.4Thisnewmodelrelesonstrategiessuchasdaiyinterruptionsofsedation,useofscoressuchastheRichmondAgitation-SedationScaltomantaintargetsedationlevel,andQ南方院右美托咪定(Dexmedetomidine)ICU應用優勢同時具有鎮靜、抗焦慮和鎮痛作用產生自然擬睡眠狀態減少麻醉藥和鎮痛藥物的需要量呼吸抑制輕微減少異常心動過速、血壓增高的發生減少寒戰降低氧消耗和氧需求對器官功能具有一定保護功能Q南方院右美托咪定的藥理特性是高選擇性α2腎上腺素能受體激動劑分布半衰期(t1/2a)5minH3消除半衰期(t1/2)2hr·蛋白結合率:94%清除率:39L/h穩態分布容積(Vs):118L代謝:肝酶P450、葡萄糖苷酸化排泄:尿:95%、大便:4%Maze.Whitepaper;2000.2.Khanetal.Anaesthesia.2019;54:146-155.3Kamibayashi,Maze.Anesthesiology.2000:93:1345-1349Q南方醬院ysiologyafAlpha-2AdrenoceachveardiaAnti-shiveringa2Bvasoconstrictinga2CC2A2AQ南方院右美托咪定的作用機制CEREBRUM作用部位腦干(