摘要
目的探讨小剂量右美托咪定在重症病人中抗谵妄和降低应激水平的作用。方法连续性纳入2015年10月至2016年6月内蒙古自治区人民医院收治的危重病人112例,采用随机数字表法分为观察组(56例)和对照组(56例)。两组均给予瑞芬太尼镇痛,观察组给予小剂量右美托咪定镇静,对照组给予咪达唑仑镇静,比较两组谵妄发生率、应激反应水平和不良反应发生率。结果相比于对照组,观察组目标镇静所需时间较长[(16.87±4.13)比(18.56±4.39)min,P=0.038],但谵妄发生率更低(30.36%比10.71%,P=0.010),首次谵妄出现时间更晚[(4.32±1.42)比(5.83±1.32)d,P<0.001],谵妄持续时间更短[(13.41±8.56)比(5.34±3.23)h,P<0.001],停药后唤醒所需时间更短[(59.65±30.82)比(14.76±6.74)min,P<0.001]。在应激反应比较中,观察组第18小时(P=0.001)及第24小时(P<0.001)血清皮质醇浓度明显低于对照组。不良反应比较中,观察组呼吸抑制发生率明显低于对照组(P=0.018),其余差异无统计学意义。结论右美托咪定可以有效降低重症病人应激反应水平,减少谵妄发生,且不良反应更少。
Objective To investigate the effect of small dose of dexmedetomidine on patients′stress reaction and incidence of delirium in intensive care unit.Methods 112 cases of critically ill patients were collected from October 2015 to June 2016,randomly divided into the study group(56 cases)and the control group(56 cases).All patients were given Fentanyl for analgesia,small dose of Dexmedetomidine were used in the study group and Midazolam was given in the control group for sedation.Incidence of delirium,stress level and the incidence of adverse reactions were compared between two groups.Results Compared with control group,the study group needed more time for goal sedation[(16.87±4.13)vs.(18.56±4.39)min,P=0.038],while the incidence of delirium was lower(30.36%vs.10.71%,P=0.010),the first appearance of delirium was later[(4.32±1.42)vs.(5.83±1.32)d,P<0.001],duration of delirium was shorter[(13.41±8.56)vs.(5.34±3.23)h,P<0.001],and awake time after drug withdrawal was shorter[(59.65±30.82)vs.(14.76±6.74)min,P<0.001].In stress reaction comparison,the study group showed significantly lower serum cortisol concentration than the control group at 18h(P=0.001)and 24 h(P<0.001).In adverse reactions comparison,the study group showed significantly lower incidence of respiratory depression than the control group(P=0.018),while the others with no statistical differences.Conclusion Dexmedetomidine can effectively reduce the severe stress level,decrease the incidence of delirium in critical ill patients,and with less adverse reaction.
作者
孟文勤
MENG Wenqin(Department of ICU,Inner Mongolia Autonomous Region People′s Hospital,Huhehot,Inner Mongolia 010017,China)
出处
《安徽医药》
CAS
2019年第3期594-597,共4页
Anhui Medical and Pharmaceutical Journal
关键词
右美托咪定
咪达唑仑
应激反应
谵妄
不良反应
Dexmedetomidine
Midazolam
Stress reaction
Delirium
Adverse reactions
