右美托咪定对肺挫伤机械通气患者的保护作用  

Protective effect of dexmedetomidine on mechanically ventilated patients with pulmonary contusion

作　　者：徐杰[1] 马明远[1] 潘永[1] 宋樱花[1] 于娜[1] 

机构地区：[1]广东省佛山市中医院重症医学科,广东佛山528000

出　　处：《中国中西医结合急救杂志》2014年第3期225-228,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省中医药管理局建设中医药强省科研项目（2010004）

摘　　要：目的探讨右美托咪定对肺挫伤机械通气患者的保护作用。方法采用前瞻性随机对照临床研究方法，选择2010年1月至2012年12月入住广东省佛山市中医院重症医学科肺挫伤机械通气患者70例，随机分为对照组和治疗组，每组35例。两组均按相同原则进行综合治疗，同时对照组给予咪达唑仑镇静，治疗组给予右美托咪定镇静。分别监测两组患者治疗后1d、5d氧合指数（PaO2/FiO2）、肿瘤坏死因子-α（TNF-α、白细胞介素-6（IL-6）以及血管外肺水指数（EVLWI）的变化。统计治疗期间两组谵妄发生率、机械通气时间、低血压发生率等。结果与治疗后1d比较，两组治疗后5d TNF-α、IL-6、EVLWI均明显降低[对照组TNF—α（ng／L）：1．29±0．38比2．21±0．37，IL-6（ng／L）：97．97±28．77比131．03±41．52，EVLWI（mL／kg）：8．25±2．03比t1．96±3．36；治疗组TNF—α：1．06±0．33比2．32±0．37，IL-6：82．07±23．35比134．98±64．25，EVLWI（mL／kg）：6．74±1．33比11．23±2．78，均P〈0．05]，PaO2／FiO2明显升高[mmHg（1mmHg=0．133kPa），对照组：285．80±30．65比213．00±33．70，治疗组：315．00±34．50比229．50±37．00，均P〈0．05]，治疗组和对照组TNF—α、IL-6变化程度相当，差异无统计学意义（TNF-α：1．06±0．33比1．29±0．38，IL-6：82．07±23．35比97．97±28．77），但治疗组EVLWI和PaO2/FiO2变化较对照组显著[EVLWI（mL／kg）：6．74±1．33比8．25±2．03，PaO2/FiO2（mmHg）：315．00±34．50比285．80±30．65，均P〈0．05]。治疗组谵妄发生率（8．57％比22．86％）、机械通气时间（d：4．10±1．09比6．88±1．66）较对照组明显下降；治疗组和对照组患者低血压发生率比较差异无统计学意义（17．14％比14．29％，P〉0．05）。结论右美托咪定对肺挫伤机械通气患者有保护作用，是此类患者较理想的镇静药物。Objective To approach the protective effect of dexmedetomidine on mechanically ventilated patients with pulmonary contusion. Methods A prospective randomly controlled trial was conducted. 70 mechanically ventilated patients with pulmonary contusion from January 2010 to December 2012 in the Critical Care Medicine of Foshan Hospital of Traditional Chinese Medicine were divided into a control group and a therapy group by the difference in number odd or even, with 35 patients in each group. Based on the same principles of comprehensive treatment, the control group used midazolam, and the therapy group used dexmedetomidine for sedation. The measured parameters included oxygenation index （PaO2/FiO2）, tumor necrosis factor-α（TNF-α）, interleukin-6 （IL-6）, and extra-vacular lung water index （EVLWI） for both groups on thelst and 5th day. The incidence of delirium, the time of mechanical ventilation, and the incidence of hypotension were observed in both groups. Results Compared with those on the 1st day, TNF-α, IL-6 and EVLWI on the 5th day were decreased significantly in both groups [ the control group TNF- α （ng/L） ： 1.29±0.38 vs. 2.21 ±0.37, IL-6 （ng/L） ： 97.97±28.77 vs. 131.03±41.52, EVLWI （mL/kg） ： 8.25±2.03 vs. 11.96 ± 3.36 ; the therapy group TNF- α ： 1.06 ± 0.33 vs. 2.32 ± 0.37, IL-6 ： 82.07 ± 23.35 vs. 134.98±64.25, EVLWI（mL/kg）： 6.74±1.33 vs. 11.23±2.78, all P〈0.05], PaO2/FiO2 was increased obviously [ mmHg （ 1 mmHg=0.133 kPa）, the control group ： 285.80 ± 30.65 vs. 213.00 ± 33.70, the therapy group ： 315.00±34.50 vs. 229.50 ± 37.00, both P〈 0.053, TNF-α and IL-6 had no significant difference compared between the therapy group and control group （TNF- α ： 1.06± 0.33 vs. 1.29 ± 0.38, IL-6 ： 82.07 ± 23.35 vs. 97.97 ± 28.77 ）, while EVLWI and PaO2/FiO2 in the therapy group had remarkable differences compared with those of the control group [ EVLWI （mL/kg） ：6.74±1.33 vs. 8.25 ±2.03, PaO2/FiO2 （mmHg） ： 315.00± 34.5

关 键 词：右美托咪定 肺挫伤 机械通气 血管外肺水指数 氧合指数 

分 类 号：R472.9[医药卫生—护理学]