不同镇静方法对胸部创伤致急性呼吸窘迫综合征患者的影响  

The Effect of Different Sedation Methods on the Patients with Acute Respiratory Distress Syndrome Caused by Chest Trauma

作　　者：张树军[1] 张勇[2] 马玉磊[2] 张明[2] 张培荣[2] 

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]潍坊医学院附属医院重症医学科

出　　处：《潍坊医学院学报》2016年第2期107-109,共3页Acta Academiae Medicinae Weifang

摘　　要：目的探讨不同镇静方法对胸部创伤致急性呼吸窘迫综合征机械通气患者的影响。方法采用前瞻性观察研究方法,选择2013年9月-2015年6月在潍坊医学院附属医院重症医学科（ICU）收治的因胸部创伤致急性呼吸窘迫综合征（ARDS）患者。将患者随机分为咪达唑仑组（M组）和右美托咪定组（Y组）,比较相同镇静深度下,两组患者的谵妄发生率、第3天及第7天的下呼吸道感染发生率、机械通气时间和ICU住院时间的差异。结果共有56例患者入选,其中M组30例,Y组26例。M组患者谵妄发生率高于Y组（73.3%,46.2%,P=0.038）,且机械通气时间[（10.3±2.4）d,（8.5±1.8）d,t=3.266,P=0.002]及ICU住院时间[（15.5±3.7）d,（12.4±3.3）d,t=3.305,P=0.002]均长于Y组。但是两组患者下呼吸道感染的发生率在第3天（20%,19.2%,χ^2=0.05,P=0.942）及第7天（0%,34.6%,χ^2=0.172,P=0.678）均无明显差别,差异无统计学意义。结论右美托咪定用于胸部创伤致急性呼吸窘迫综合征机械通气患者时,可能更有利于减少患者谵妄的发生,有利于缩短患者机械通气时间及ICU住院时间,但不能降低患者下呼吸道感染发生率。Objective To investigate the effect of different sedation methods on the patients with acute respiratory distress syndrome and mechanical ventilation caused by chest trauma. Methods The method was based on the prospective observational study. The patients with acute respiratory distress syndrome（ ARDS） caused by thoracic trauma were selected from department of Intensive Care Unit（ ICU）of the affiliated hospital of weifang medical university from September 2013 to June 2015. They were randomly divided into the Midazolam group（ group M） and the Dexmedetomidine group（ group Y）. Compared and recorded the incidence of delirium,the incidence of the lower respiratory tract infections in the 3th and 7th day,the mechanical ventilation time and the length of ICU stay under the same depth of sedation between the two groups. Results Fifty-six consecutive adult patients were enrolled,including 30 cases in group M and 26 cases in group Y.The delirium incidence in group M（ 73. 3%） was higher than that of group Y（ 46. 2%）（ P = 0. 038）,and the mechanical ventilation time[（ 10. 3 ± 2. 4） d,（ 8. 5 ± 1. 8） d,t = 3. 266,P = 0. 002） ]and ICU hospital time[（ 15. 5 ± 3. 7） d,（ 12. 4 ± 3. 3） d,t = 3. 305,P = 0. 002） ]in group M were both longer than those of group Y,but there were no significant differences in the incidence of lower respiratory tract infection either in the 3th day（ 20%,19. 2%,χ^2= 0. 05,P = 0. 942） or in the 7th day（ 40%,34. 6%,χ^2= 0. 172,P = 0. 678）. Conclusion Dexmedetomidine may have a better effect on the patients with acute respiratory distress syndrome caused by chest trauma,it can reduce the incidence of delirium and shorten the mechanical ventilation time and the length of ICU stay. However,it cannot reduce the incidence of lower respiratory tract infections.

关 键 词：镇静 胸部创伤 呼吸窘迫综合征 急性 机械通气 咪达唑仑 右美托咪定 

分 类 号：R563.8[医药卫生—呼吸系统]