摘要
目的:确定夜间服用右美托咪定是否能预防危重患者的精神错乱和改善睡眠。方法:选取2018年11月24日至2022年1月22日山东大学齐鲁医院ICU病房接受镇静剂治疗的无妄想症危重患者100例作为研究对象,随机分为观察组和对照组,每组50例。观察组患者夜间(21:30-6:15)使用右美托咪定治疗,对照组患者给予安慰剂治疗。在研究进行期间,液体滴注中镇静剂减半;阿片类药物没有变化。在ICU入院期间,每隔12 h使用重症监护谵妄筛查量表(ICDSC)对精神错乱进行评估。每天早上用利兹睡眠评估问卷(LSEQ)评估睡眠状况。结果:夜间使用低剂量右美托咪定(与安慰剂比较)的患者在ICU住院期间保持无谵妄状态的比例更高(其中使用右美托咪定的50例患者中的40例保持无谵妄状态,占比80%;使用安慰剂对照的50例患者中仅有27例患者无谵妄状态,占比54%)(RR=0.44,95%CI为0.23~0.82,P=0.006)。34例接受右美托咪定滴注的患者和30例使用安慰剂的患者平均LSEQ评分相似(MD=0.02,95%CI为0.42~1.92)。低血压、心动过缓二者的发生率在2组之间没有明显差异。结论:重症患者夜间使用小剂量右美托咪定可降低ICU住院期间谵妄的发生率,且患者的睡眠质量没有受到影响。
Objective:To determine whether nocturnal administration of dexmetomidine can prevent psychosis and improve sleep in critically ill adults.Methods:From November 24,2018 to January 22,2022,100 serious patients without delusions in ICU wards of Qilu Hospital of Shandong University who received sedative treatment were selected as research objects,and were randomly divided into an observation group and a control group,with 50 cases in each group.The observation group patients were treated with dexmedetomidine at night(21:30-6:15),while the control group patients were treated with placebo.During the study,tranquilizers were halved in liquid drips;opioids did not change.During the admission of ICU,the intensive care delirium screening scale(ICDSC)was used to evaluate mental disorder every 12 hours.Sleep status was assessed with the Leeds Sleep Assessment questionnaire(LSEQ)every morning.Results:Patients who received low-dose dexmedetomidine at night(compared with placebo)were more likely to remain in a delirium-free state during ICU hospitalization(40 of the 50 patients treated with dexmetomidine,80%;only 27 of the 50 patients treated with placebo,54%)(RR=0.44,95%CI 0.23 to 0.82 paired 0.006).The average LSEQ score of 34 patients who received dexmedetomidine was similar to that of 30 patients who received placebo(MD=0.02;95%CI 0.42 to 1.92).There was no significant difference in the incidence of hypotension and bradycardia between the two groups.Conclusion:Nocturnal administration of low-dose dexmedetomidine in critically ill patients can reduce the incidence of delirium during hospitalization in ICU.In addition,the sleep quality of the patients was not affected.
作者
王宏博
WANG Hongbo(Intensive Care Unit of Cardiac Surgery,Qilu Hospital,Shandong University,Ji′nan 250000,China)
出处
《世界睡眠医学杂志》
2023年第4期697-701,共5页
World Journal of Sleep Medicine
关键词
谵妄
睡眠
重症监护
右美托咪定
随机对照试验
Delirium
Sleep
Intensive care
Dexmetomidine
Randomized controlled trial
