右美托咪定、咪达唑仑、丙泊酚治疗AECOPD伴呼吸衰竭的临床效果  

Comparison of application of dexmedetomidine, midazolam and propofol in the treatment of AECOPD with respiratory failure

作　　者：程书立 许继元[1] 马丽丽[1] 孙胜利[1] 

机构地区：[1]徐州市中心医院ICU,江苏徐州221009

出　　处：《热带医学杂志》2016年第9期1163-1167,共5页Journal of Tropical Medicine

摘　　要：目的探讨右美托咪定、咪达唑仑及丙泊酚在慢性阻塞性肺疾病急性加重期(AECOPD)伴呼吸衰竭患者临床治疗中的效果。方法选取2011年10月至2014年3月徐州市中心医院重症监护室收治的105例慢性阻塞性肺疾病急性加重期(AECOPD)伴呼吸衰竭患者为研究对象,采用随机抽样法将其分成右美托咪定组(A组,n=35)、咪达唑仑组(B组,n=35)和丙泊酚组(C组,n=35)三组,均在气管插管机械通气基础上予以镇静治疗措施方案。比对三组患者睡眠质量评分、镇静起效时间、ICU留住时间、停药后清醒时间、机械通气时间等治疗指标差异,记录其用药前后各呼吸指标变化情况;行为期1个月随访,分析其辅助镇痛药物比例、48 h内再插管率、30 d内死亡率及不良反应发生率差异。结果三组患者匹兹堡睡眠质量指数(PSQI)评分对比差异无统计学意义(P>0.05);A组患者镇静起效时间、ICU留住时间、停药后清醒时间及机械通气时间均显著低于B、C组患者(P<0.05);且B、C两组患者上述各治疗指标对比差异无统计学意义(P>0.05)。用药后,三组患者HR、RR、MAP等呼吸指标均较用药前显著降低,SpO_2水平则较用药前显著提高(P<0.05);其中A组患者各指标变化幅度均显著大于B、C组患者(P<0.05);B、C组患者各呼吸指标变化幅度对比差异无统计学意义(P>0.05);随访期内,A组患者辅助镇痛药物比例、48 h内再插管率、30 d死亡率、呼吸抑制及谵妄等不良反应发生率均显著低于B、C组患者(P<0.05),且低血压及窦性心动过缓等不良反应发生率显著高于B、C组患者(P<0.05);B、C组患者在上述各随访期指标对比差异无统计学意义(P>0.05)。结论对行机械通气治疗的AECOPD伴呼吸衰竭患者予以右美托咪定镇静方案,镇静效果良好,用药安全性突出,值得临床推广。Objective To investigate the differences and clinical value of dexmedetomidine, midazolam and propofol in the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD） with respiratory failure. Methods105 patients with AECOPD complicated with respiratory failure were selected as the research objects. With random sampling method, the objects were divided into the dexmedetomidine group（group A,n =35）, the midazolam group（group B,n=35） and the propofol group（Group C,n=35）. The three groups were given sedative treatment measures,based on endotracheal intubation mechanical ventilation. The sleep quality scores, sedation onset time, length of stay in ICU, awaken time after drug withdrawal, mechanical ventilation time and other treatment indexes were compared within the three groups.The changes of respiratory parameters were recorded before and after the treatment. Witha month of follow-up in the behavior phase, the proportion of the adjuvant analgesics, the rate of re-intubation within 48 h,mortality within 30 d and incidence rate of adverse reactions were analyzed. Results There was no statistical significant difference in the comparison of PSQI scores（P〉0.05）. In group A, the onset time of sedation, length of stay in ICU,awaken time after drug withdrawal and mechanical ventilation time were significantly lower than those in group B and C（P〈0.05）.And there was no statistical significant differences in the comparison of above treatment indexes between group B and C（P〉0.05）.After medication, HR, RR, MAP and other respiratory indexes in the three groups were significantly lower than those before medication while the SpO2 level was significantly higher than that before medication（P〈0.05）.The varied range of each index in A group was significantly greater than that in group B and C（P〈0.05）. The comparison of the varied range of each index between group B and C had no significant difference（P〉0.05）. During thefollow-up, the proportion of the adjuvant

关 键 词：右美托咪定 咪达唑仑 丙泊酚 AECOPD 呼吸衰竭 

分 类 号：R563.8[医药卫生—呼吸系统]