右美托咪定用于慢性阻塞性肺疾病急性发作患者拔管后序贯无创机械通气镇静临床研究  

Clinical study of dexmedetomidine for sequential noninvasive mechanical ventilation sedation after extubation in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：刘亚卿 陈虎 刘健 黎丽 Liu Yaqing;Chen Hu;Liu Jian;Li Li(Department of Critical Care Medicine, Second People' s Hospital of Pingxiang, Pingxiang, Jiangxi, 337000, China)

机构地区：[1]江西省萍乡市第二人民医院重症医学科

出　　处：《当代医学》2019年第25期27-29,共3页Contemporary Medicine

摘　　要：目的比较右美托咪定(DEX)与传统镇静药物(咪达唑仑或丙泊酚)对慢性阻塞性肺疾病急性加重(AECOPD)患者拔管后序贯无创机械通气的镇静的临床效果.方法回顾性分析本院重症医学科收治44例接受有创机械通气的AECOPD患者拔管后序贯无创机械通气,将患者随机分为两组,观察组(n=22)采用DEX镇静治疗,对照组(n=22)采用传统的咪达唑仑或丙泊酚镇静治疗,比较两组患者的谵妄发生率,再插管率,过度镇静率及拔管后ICU停留时间.结果观察组与对照组患者拔管前一般情况评估,性别[男性(例)16:14],年龄[(58.2±6.5)vs.(56.8±7.2)岁],急性生理学与慢性健康状况评分Ⅱ[APACHE(15.9±3.5)vs.(16.2±2.3)分],拔管前氧合指数[(262±48)vs.(265±56)]等基线资料比较差异无统计学意义.与对照组比较,观察组的谵妄发生率显著降低(9.1%vs.18.2%,P<0.01),过度镇静比率明显下降(4.5%比13.7%,P<0.05),拔管后ICU停留时间明显缩短[(3.2±0.8)vs.(5.3±0.5),P<0.05],拔管后48 h再插管率比较差异无统计学意义.结论在接受有创机械通气的AECOPD患者拔管后序贯无创机械通气过程中使用DEX镇静方案能提高人机同步性和舒适感,降低镇静不良事件发生率,缩短ICU住院时间传统镇静方案比较存在明显优势.Objective To compare the clinical sedation of dexmedetomidine (DEX) with traditional sedative drugs (midazolam or propofol) for sequential non-invasive mechanical ventilation after extubation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective analysis of 44 patients with AECOPD who underwent invasive mechanical ventilation received sequential non-invasive mechanical ventilation after intubation in the hospital .The patients were randomly divided into two groups. The observation group (n=22) was treated with DEX sedation groups (n=22) were treated with conventional midazolam or propofol sedation. The incidence of sputum, reintubation rate excessive sedation rate and ICU stay time after extubation were compared between the two groups. Results The general condition of the observation group and the control group before xtubation was evaluated gender [male (case)16∶14],age [(58.2±6.5) vs.(56.8±7.2) year, acute physiology and chronic health status score II [APACHE(mites)]. There were no significant differences in baseline data between [(15.9±3.5) vs.(16.2±2.3)] and oxygention index before extubation (262±48) vs.(265±56). Compared with the control group, the incidence of sputum in the observation group was significantly lower (9.1% vs.18.2%, P<0.01), and the excessive sedation rate was significantly decreased (4.5% vs.13.7%, P<0.05). The ICU stay time was significantly shortened after extubation [(3.2±0.8) vs.(5.3±0.5), P<0.05], there was no significant difference in intubation rate at 48 after extubation. Conclusion The use of DEX sedation in the sequential non-invasive mechanical ventilation of patients with AECOPD undergoing invasive mechanical ventilation can improve synchrony and comfort, reduce the incidence of sedation adverse vents, and shorten the ICU hospitalization time obvious advantage.

关 键 词：右美托咪定 镇静 肺疾病 慢性阻塞性 无创机械通气 

分 类 号：R563.9[医药卫生—呼吸系统]