右美托咪定在ICU机械通气集束化治疗中的临床应用研究  

A study of using dexmedetomidine in ventilator bundle treatment in an ICU

作　　者：宋瑞霞[1] 李俊艳[1] 董晨明[1] 杨静[1] 

机构地区：[1]兰州大学第二医院重症医学一科,甘肃兰州730030

出　　处：《中华危重病急救医学》2015年第10期836-840,共5页Chinese Critical Care Medicine

基　　金：甘肃省卫生行业科研计划项目（GSWSKY-2014-32）

摘　　要：目的：比较右美托咪定与咪达唑仑对重症加强治疗病房（ICU）机械通气集束化治疗患者的镇静效果及安全性。方法采用前瞻性单盲随机对照试验（RCT），以2013年1月至2014年12月兰州大学第二医院重症医学一科收治的90例行机械通气集束化治疗≥3 d的重症患者为研究对象，按随机数字表法分为两组进行镇静治疗。右美托咪定组（42例）给予右美托咪定0.2～0.7μg·kg-1·h-1维持，直至获得满意的目标镇静〔白天Richmond躁动-镇静评分（RASS）为0～-2分，夜间RASS为-1～-3分〕；咪达唑仑组（48例）静脉注射咪达唑仑2～3 mg，继而以0.05 mg·kg-1·h-1静脉滴注维持。两组每隔4 h根据RASS调整研究药物剂量，维持恰当的镇静深度；均予以芬太尼持续镇痛；呼吸机集束化治疗包括：床头抬高30°～45°，每日唤醒并进行拔管评估，使用质子泵抑制剂预防消化性溃疡，预防深静脉血栓形成（DVT），洗必泰口腔护理，持续声门下吸痰等。两组患者获得满意的目标镇静后，实行每日唤醒，行自主呼吸试验（SBT）脱机筛查，评估患者脱机条件，达到脱机条件者脱机，不能脱机者则继续给予集束化治疗。记录患者用药前和用药后15、30、60、120、180 min，以及拔管时和拔管后30 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、自主呼吸频率（RR）；机械通气时间、拔管时间、ICU住院时间，以及不良反应事件的发生率。结果右美托咪定与咪达唑仑均能使患者达到镇静、镇痛目标评分，且两组镇静、镇痛效果相似。与咪达唑仑组相比，右美托咪定组可明显缩短机械通气时间（h：108.33±21.96比119.85±20.29，t＝-2.586，P＝0.011）、拔管时间（h：112.95±22.20比128.58±26.18，t＝-3.031，P＝0.003）、ICU住院时间（h：149.21±20.47比163.88±33.59， t＝-2.457，P＝0.016），明显降低谵妄�ObjectiveTo compare the sedative effect and safety of dexmedetomidine and midazolam in the intensive care unit （ICU） patients undergoing ventilator bundle treatment.MethodsA prospective single-blind randomized controlled trial （RCT） was conducted. Ninety patients receiving ICU ventilator-assisted therapy and ventilator bundle treatments for more than 3 days in the First Department of Critical Care Medicine of the Second Hospital of Lanzhou University from January 2013 to December 2014 were enrolled. The patients were randomly divided into two groups for sedative treatment. The patients in dexmedetomidine group （n = 42） were given dexmedetomidine 0.2-0.7μg·kg-1·h-1 to achieve a goal of satisfactory sedation [Richmond agitation-sedation scale （RASS） score＆amp;nbsp;0 to - 2 during the day, and -1 to -3 at night）. The patients in midazolam group （n = 48） were given midazolam 2-3 mg intravenously first, and then 0.05 mg·kg-1·h-1 for maintenance. The drug dose was adjusted according to RASS every 4 hours to maintain the appropriate sedation depth. The patients in both groups received continuous intravenous infusion of fentanyl for analgesia. Ventilator bundle treatments included the head of a bed up 30°to 45°, awaken and extubation appraisal, daily use of proton pump inhibitors for peptic ulcer prevention, prevention of deep vein thrombosis （DVT）, chlorhexidine mouth nursing, and removal of sputum by suction from subglottic area. When the patients in both groups obtained satisfactory target sedation, daily awakening was conducted, and spontaneous breathing test （SBT） was carried out to determine optional weaning time. When the condition was optimal, weaning was conducted, otherwise ventilator bundle treatments were continued. The systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, heart rate （HR）, respiratory frequency （RR） were monitored before and 15, 30, 60, 120, 180 minutes after the treatment, and at the moment of e

关 键 词：右美托咪定 咪达唑仑 机械通气集束化治疗 镇静 谵妄 

分 类 号：R459.7[医药卫生—急诊医学]