轻度持续镇静对多发伤患者的镇静效果及炎症反应的影响  

Influence of continuous mild sedation on sedative effect and inflammatory response in multiple trauma patients

作　　者：李勇[1] 金兆辰[1] 蔡燕[1] 吉木森[1] 杨宏锋[1] 刘竞[1] 虞志新[1] 

机构地区：[1]江苏大学附属人民医院重症医学科,镇江212002

出　　处：《中华创伤杂志》2016年第1期64-68,共5页Chinese Journal of Trauma

基　　金：江苏省镇江市科技计划（社会发展科技支撑）项目（SH2014052）

摘　　要：目的比较轻度持续镇静和常规镇静对ICU多发伤患者镇静效果和炎症反应的影响。方法采用前瞻性随机对照方法，将2013年10月-2015年4月江苏大学附属人民医院收治的58例多发伤患者按照随机信封法分为轻度持续镇静组（持续组，30例）和常规镇静组（常规组，28例）。比较两组患者机械通气使用持续时间、住ICU时间、连续肾脏替代治疗（CRRT）使用率、气管切开率、气管插管意外拔管率、脓毒症发生率、多脏器功能衰竭（MOF）发生率、病死率等。并测定入住ICU后24，48，72h炎性指标变化。结果两组患者病死率差异无统计学意义，持续组死亡3例（10％），常规组死亡4例（14％）（P〉0．05）。持续组机械通气时间短于对照组[（4．8±2．7）d：（8．9±3．1）d]（P〈0．01），持续组住ICU时间短于对照组[（10．7±5．4）d：（16．9±7．3）d]（P〈0．01）。两组患者CRRT、气管切开率、气管插管意外拔管率、脓毒症发生率和MOF发生率差异无统计学意义。持续组血清炎症因子白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、C反应蛋白（CRP）水平在24，48，72h低于常规组，仅48h时比较，差异有统计学意义（P〈0．05）。相应时间段血清IL-10水平持续组高于常规组（P〈0．05）。持续组入住ICU48h血清IL-6、IL-10、TNF-α、CRP水平在受试者工作特征（ROC）曲线下面积（AUC）分别为0．726，0．608，0．729，0．757，对脓毒症有一定预测价值。结论轻度持续镇静对多发伤患者是可行的，可以缩短住ICU时间，减轻炎症反应。Objective To determine the influence of continuous mild sedation versus usual sedation on the sedative effect and inflammatory factor level in ICU patients with muhiple trauma. Methods In this prospective, randomized double-blind investigation, 58 multiple trauma patients hospitalized from October 2013 to April 2015 were randomized into continuous mild sedation group （continuous group, n = 30） and conventional sedation group （ conventional group, n = 28） using the sealed envelopes. Between-group differences were made on the duration of mechanical ventilation, length of stay in the ICU, ratio of inception of continuous renal replacement therapy （CRRT） , tracheotomy rate, accidental extubation rate, sepsis rate, muhiple organ failure （MOF） rate and mortality. Serum inflammatory factor levels of the patients were recorded. Results There were 3 deaths （ 10% ） in continuous group versus 4 deaths （ 14% ） in conventional group （ P 〉 0.05 ）. Patients in continuous group showed significantly less time spent on mechanical ventilation [ （4.8±2.7） vs. （8.9 ± 3.1 ）d] and in the ICU [ （ 10.7 ± 5.4 ） vs. （ 16.9 ± 7.3 ） d] compared with conventional group （ P 〈 0.01 ）. Between-group differences were insignificant regarding the ratio of CRRT inception, tracheotomy rate, accidental extubation rate, sepsis rate and MOF rate （P 〉 0.05 ）. Serum levels of interleukin （IL）45, tumor necrosis factor （TNF）-α, Creactive protein （CRP） were lower in continuous group than those in conventional group at 24 h, 48 h and 72 h post-ICU, but significant differences were only observed at 48 h （ P 〈 0. 05 ）. At these time periods, serum IL-10 levels in eontinuous group were significantly higher than those in conventional group （P 〈 0.05 ）. In receiver operative characteristic curve （ROC） analysis, the area under the curve for IL-6, IL-10, TNF-α and CRP in continuous group was 0. 726, 0. 608, 0. 729 and 0. 757 respectively at 48 h post-ICU, indicating a predict

关 键 词：镇痛 多处损伤 炎症因子 

分 类 号：R641[医药卫生—外科学]