右美托咪定对慢性阻塞性肺疾病急性加重期行机械通气患者的镇静效果观察  

Effect of dexmedetomidine on sedation during mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：张远超[1] 喻莉[1] 耿峰[1] 刘伟[1] 廖仕翀[1] 

机构地区：[1]武汉市中心医院重症医学科,430014

出　　处：《中华实用诊断与治疗杂志》2016年第12期1242-1244,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：武汉市卫生局资助项目(WX12C35)

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）行机械通气患者应用右美托咪定镇静的有效性及安全性。方法 AECOPD需行机械通气治疗患者48例,随机分为观察组和对照组各24例。观察组机械通气前给予右美托咪定负荷量1μg/kg缓慢静脉注射10 min后以0.2-0.6μg/（kg·h）静脉泵注维持;对照组机械通气前给予咪达唑仑负荷剂量0.06 mg/kg缓慢静脉注射10 min后以0.04-0.20mg/（kg·h）静脉泵注维持。记录2组镇静开始、镇静2h平均动脉压、心率、呼吸频率、动脉血氧饱和度、气道峰压;统计2组镇静治疗过程中芬太尼用量、停药后清醒时间、机械通气时间、ICU住院时间;比较2组机械通气镇静治疗过程中心血管不良事件发生率。结果镇静治疗2h,观察组、对照组心率[（85.8±15.7）、（94.7±13.0）次/min]、呼吸频率[（26.9±4.7）、（21.6±2.9）次/min]、气道峰压[（2.362±0.627）、（2.617±0.578）kPa]均较治疗前[（119.1±15.6）、（126.8±13.3）次/min,（37.6±3.6）、（35.8±4.9）次/min,（3.107±0.843）、（3.067±0.725）kPa]明显下降（P〈0.05）,动脉血氧饱和度[（94.7±5.3）%、（93.2±8.2）%]均较治疗前[（66.0±14.1）%、（71.4±12.2）%]增高（P〈0.05）;观察组心率、呼吸频率下降较对照组明显（P〈0.05）;观察组芬太尼用量[（0.29±0.13）μg/（kg·h）]较对照组[（0.40±0.12）μg/（kg·h）]少,停药后清醒时间[（42.2±6.6）min]、机械通气时间[（5.12±1.28）d]、ICU住院时间[（7.05±1.38）d]较对照组[（80.1±11.2）min、（6.18±1.56）d、（8.01±1.56）d]短（P〈0.05）;观察组用药期间心动过缓发生率（33.33%）、心动过速发生率（12.50%）、低血压发生率（16.67%）与对照组（25.00%,16.67%,25.00%）比较差异均无统计学意义（P〉0.05）。结论右美托咪定、咪达唑仑用于AECOPD需行机械通气患者镇静治Objective To observe the effectivity and safety of dexmedetomidine in sedation during mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods Forty-eight AECOPD patients receiving mechanical ventilation were randomly divided into observation group and control group,with 24 patients in each group.Observation group received intravenous injection of 1μg/kg dexmedetomidine within 10 min followed by intravenous pump of 0.2to 0.6μg/（kg·h）before mechanical ventilation.Control group received intravenous injection of0.06μg/kg midazolam within 10 min followed by intravenous pump of 0.04 to 0.20mg/（kg·h）.The values of mean arterial pressure,heart rate,respiratory frequency,arterial oxygen saturation and peak airway pressure were detected at the beginning of sedation and in 2hafter sedation.The dosage of fentanyl,the awakening time,the length of mechanical ventilation,and the length of ICU were compared between two groups.The incidence of adverse cardiovascular event was observed.Results In 2hafter sedation,the heart rates（（85.8±15.7）,（94.7±13.0）beat/min）,respiratory frequencies（（26.9±4.7）,（21.6±2.9）beat/min）,airway peak pressure（（2.362±0.627）,（2.617±0.578）kPa）in observation group and control group were significantly lower after 2-h sedation than those before sedation（（119.1±15.6）,（126.8±13.3）beat/min;（37.6±3.6）,（35.8±4.9）beat/min;（3.107±0.843）,（3.067±0.725）kPa）（P〈0.05）,and the arterial oxygen saturation（SaO2）values（（94.7±5.3）%,（93.2±8.2）%）in two groups after 2-h sedation were significantly higher than those before sedation（（66.0±14.1）%,（71.4±12.2）%）（P〈0.05）.The decrease of heart rate and respiratory frequency were more obvious in observation group than that in control group（P〈0.05）.The dosage of fentanyl was significantly smaller in observation group（（0.29±0.13）μg/（kg·h））than that incontrol group（（0.40±0.

关 键 词：慢性阻塞性肺疾病急性加重期 机械通气 右美托咪定 咪达唑仑 

分 类 号：R563.9[医药卫生—呼吸系统]