PiCCO精细化监测评估右美托咪定对ARDS患者肺水肿的影响  

Pi CCO refined monitoring to evaluate the effect of dexmedetomidine on pulmonary edema in patients with ARDS

作　　者：蒋玲玉[1] 韩林[1] 熊滨[1] 向淑麟[1] 莫丽[1] JIANG Ling-yu;HAN Lin;XIONG Bin(Department of Critical Care Medicine,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院重症医学科

出　　处：《中国临床新医学》2020年第2期149-153,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西卫健委科研课题(编号:Z2011466)

摘　　要：目的通过脉搏指示持续心排血量(PiCCO)精细化监测评估右美托咪定对接受机械通气治疗的成人急性呼吸窘迫综合征(ARDS)患者肺水肿及血清学指标的影响。方法收集该院重症医学科住院的成人ARDS患者60例,采用随机数字表法将其分为右美托咪定组和丙泊酚组,每组30例。患者在充分镇痛基础上,分别给予右美托咪定(右美托咪定组)和丙泊酚(丙泊酚组)镇静治疗。所有患者行PiCCO监测,比较两组患者在予镇静治疗后第0 h、24 h、48 h和72 h时间点的氧合指数、血管外肺水指数(EVLWI)、肺血管通透性(PVPI)及血清学指标C反应蛋白(CRP)、降钙素原(PCT)。结果两组患者在年龄、性别、序贯器官衰竭评分(SOFA)和最初氧合指数等方面比较差异均无统计学意义(P>0.05),所有患者能达到目标镇静效果。两组患者氧合指数随时间呈上升趋势。两组EVLWI、PVPI、CRP和PCT随时间呈下降趋势,但两组间变化趋势比较差异无统计学意义(P>0.05)。结论使用右美托咪定镇静治疗可改善成人ARDS患者肺水肿情况及全身炎症反应,其改善程度不亚于丙泊酚。Objective To observe the effect of dexmedetomidine on pulmonary edema and serological indicators in adult patients with acute respiratory distress syndrome(ARDS)treated with mechanical ventilation through pulse-indicated continuous cardiac output(PiCCO)refined monitoring.Methods Sixty cases of adult ARDS patients in the Department of Critical Care Medicine of the People′s Hospital of Guangxi Zhuang Autonomous Region were collected and randomly divided into dexmedetomidine group and propofol group by random number table method,with 30 cases in each group.On the basis of sufficient analgesia,the patients were sedated with dexmedetomidine(the dexmedetomidine group)and propofol(the propofol group).All the patients were monitored with PiCCO,and the oxygenation index,extravascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI)and serological indexes C-reaction protein(CRP),procalcitonin(PCT)were compared between the two groups at 0,24,48 and 72 hours after sedation.Results There were no significant differences in age,gender,Sequential Organ Failure Assessment(SOFA)score and initial oxygenation index between the two groups(P>0.05).The target sedative effect was achieved in all the patients.The oxygenation index of the patients in the two groups increased with time,while EVLWI,PVPI,CRP and PCT in the two groups decreased with time,but there were no significant differences between the two groups(P>0.05).Conclusion Sedation with dexmedetomidine can improve pulmonary edema and systemic inflammatory response in adult patients with ARDS,and the improvement of dexmedetomidine is no less than that of propofol.

关 键 词：急性呼吸窘迫综合征 右美托咪定 血管外肺水指数 

分 类 号：R563[医药卫生—呼吸系统]