摘要
目的探讨右美托咪定在AECOPD并机械通气患者镇静治疗中的应用。方法将2016年1月至2017年6月收治需要机械通气治疗的68例AECOPD患者随机分为右美托咪定组(试验组)和咪达唑仑组(对照组),每组34例。两组患者分别予以右美托咪定和咪达唑仑行诱导插管及维持镇静,并在机械通气后予芬太尼静脉泵注行基础镇痛。记录两组患者ICU住院时间、机械通气时间、芬太尼用量和停药后清醒时间。记录两组患者镇静开始时(T0)、2h(T1)的平均动脉压、心率、呼吸频率、氧合指数、气道峰压的变化。统计两组患者镇静治疗过程中意外拔管、谵妄、心血管不良事件和VAP发生率。结果与对照组比较,试验组ICU住院时间、机械通气时间、停药后清醒时间明显缩短,芬太尼的用量明显减少(P<0. 05)。与同组治疗前比较,全部患者治疗2h后心动过速、呼吸急促、气道高峰压的情况均有所好转,氧合明显改善(P<0. 05)。与对照组相比,试验组治疗2h后患者HR、RR下降更为明显(P<0. 05)。试验组谵妄发生率和VAP发生率远低于对照组(P<0. 05);两组意外拔管率和心血管不良事件发生率无统计学意义(P>0. 05)。结论右美托咪定在AECOPD并机械通气患者镇静效果满意,用药过程中呼吸系统、神经系统并发症发生率低,血流动力学稳定,值得在临床推广。
Objective To investigate the application of Dexmedetomidine on the sedation of AECOPD patients under mechanical ventilation. Methods 68 cases of AECOPD patients requiring mechanical ventilation received from January 2016 to June 2017,were randomly divided into Dexmedetomidine group(experimental group)and Midazolam group(control group),34 cases for each.Patients were administrated Dexmedetomidine or Midazolam respectively for induction during intubation and maintenance of sedation,along with Fentanyl for analgesia during ventilation.Length of ICU stay,duration of ventilatory support,dosage of Fentanyl and awakening time of patients in the two groups were recorded.At initiation of sedation(T 0 )and 2 hours after initiation(T 1 ),mean arterial pressure,heart rate(HR),respiratory rate(RR),oxygenation index and peak airway pressure were recorded.Incidence of unplanned extubation,delirium,adverse cardiovascular events and ventilation associated pneumonia(VAP)during sedation were recorded. Results Compared with control group,length of ICU stay,duration of ventilatory support and awakening time in experimental group shortened significantly,and dosage of Fentanyl reduced significantly( P <0.05).Within the same group,all patients acquired improvement in RR,HR,peak airway pressure and oxygenation function after 2 hours of treatment,compared with conditions before treatment( P <0.05).Reduction of HR and RR after 2-hours treatment was more significant in experimental group than control group( P <0.05).Incidences of delirium and VAP in experimental group were significantly lower than those in control group( P <0.05),while there was no statistically significant difference in incidence of unplanned extubation and adverse cardiovascular events between the two groups( P >0.05). Conclusion Dexmedetomidine has satisfying sedative effect in AECOPD patients under mechanical ventilation,with low incidence of complications in respiratory system and nervous system and stable hemodynamics,worthy of clinical promotion.
作者
李梅
李萍
王花
Li Mei;Li Ping;Li Ping(Department of Critical Care Medicine,Wuhan Central Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430014,China)
出处
《四川医学》
CAS
2018年第12期1390-1393,共4页
Sichuan Medical Journal
关键词
右美托咪定
慢性阻塞性肺病急性加重期
机械通气
镇静
dexmedetomidine
acute exacerbation of chronic obstructive pulmonary disease(AECOPD)
mechanical ventilation
sedation
