右美托咪定对老年重症肺炎病人兴奋型谵妄的改善作用  

A retrospective study on the effect of dexmedetomidine for improving excitatory delirium in elderly patients with severe pneumonia

作　　者：窦立冬 郭翃江[1] 纪红[1] DOU Lidong;GUO Hongjiang;JI Hong(Department of Geriatric Medicine,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院老年医学二科

出　　处：《安徽医药》2020年第2期390-392,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨右美托咪定对老年重症肺炎病人兴奋型谵妄的改善作用。方法回顾分析2017年1月至2018年12月航天中心医院收治的老年重症肺炎发生兴奋型谵妄病人55例,分为观察组和对照组,对照组(23例)给予口服奥氮平治疗,观察组(32例)口服奥氮平基础上加用右美托咪定泵入治疗。对比两组病人基本情况,用药前后谵妄评定方法中文修订版(CAM-CR)评分、Ricker评分、临床总体印象量表病情严重程度(CGI-SI)评分,以及谵妄持续时间、抗生素疗程、肺炎预后。结果两组病人性别、年龄、平均动脉压(MAP)、心率、呼吸频率、氧合指数、急性生理与慢性健康(APACHEⅡ)评分差异无统计学意义(P>0.05);两组病人用药前CAM-CR评分、Ricker评分、CGI-SI评分差异无统计学意义(P>0.05);观察组用药后48 h CAM-CR评分(14.8±2.4)分、Ricker评分(3.9±0.6)分、CGI-SI(1.7±0.8)分明显低于对照组(17.5±2.1)、(4.2±0.5)、(2.4±0.7)分(P<0.05);观察组谵妄持续时间(4.2±1.3)d、抗生素使用时间(12.1±4.7)明显短于对照组(2.4±0.7)d、(14.7±5.5)d(P<0.05);两组病人肺炎预后差异无统计学意义(P>0.05)。结论右美托咪定明显改善老年重症肺炎病人兴奋型谵妄,而且缩短抗生素使用时间。Objective To explore the effect of dexmedetomidine on the excitatory delirium in elderly patients with severe pneumonia.Methods Clinical data of 55 elderly patients with severe pneumonia complicated with excitatory delirium in Aerospace Center Hospital from Jan. 2017 to Dec. 2018 were retrospectively reviewed.The patients were divided into 2 groups,control group(n=23)received oral olanzapine,observation group(n=32)received dexmedetomidine intravenously in addition to oral olanzapine.Basic conditions,CAM-CR score,Ricker score,CGI-SI score before and after treatment,as well as the duration of delirium,course of antibiotic,and prognosis were compared between the two groups.Results There were no significant differences between the two groups in gender,age,MAP,heart rate,respiratory rate,oxygenation index,and APACHE II score(P>0.05);There were no significant differences in CAM-CR score,Ricker score,and CGI-SI score before treatment between the two groups(P>0.05).The CAM-CR score[(14.8±2.4)vs.(17.5±2.1)],Riker score[(3.9±0.6)vs.(4.2±0.5)],and CGI-SI score[(1.7±0.8)vs.(2.4±0.7)]after 48-hour treatment were significantly lower in the observation group than in the control group(P<0.05);The duration of delirium[(4.2±1.3)vs.(2.4±0.7)]and use of antibiotics[(12.1±4.7)vs.(14.7±5.5)]in the observation group were significantly shorter than those in the control group(P<0.05).There was no significant difference in the prognosis of pneumonia between the two groups(P>0.05).Conclusion Dexmedetomidine significantly improved the excitatory delirium in elderly patients with severe pneumonia and shortened the use of antibiotics.

关 键 词：谵妄 肺炎 右美托咪定 奥氮平 老年人 

分 类 号：R563.1[医药卫生—呼吸系统]