不同镇静方法对AECOPD呼吸衰竭患者预后的影响  

Effects of different sedation methods on the prognosis of patients with AECOPD respiratory failure

作　　者：李强[1] 杨明全[1] 周洁[1] Li Qiang;Yang Mingquan;Zhou Jie(ICU of Zigong First People's Hospital,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第一人民医院ICU,四川自贡643000

出　　处：《医药前沿》2020年第23期34-36,共3页Journal of Frontiers of Medicine

摘　　要：目的:观察不同镇静方法对慢性阻塞性肺疾病急性加重期AECOPD呼吸衰竭患者预后的影响。方法:选取2015年3月-2018年5月我院ICU抢救的AECOPD伴呼呼衰竭患者258例。根据镇静药物的选择不同将符合条件的患者随机分成3组,即咪达唑仑+舒芬太尼(MS)组、右美托咪定+舒芬太尼(D S)组和右美托咪定+咪达唑仑+舒芬太尼(DMS)组进行分析。收集整理所有参与患者的临床资料,对性别、年龄、入ICU24h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,CPOT镇痛评分,RASS或RAMSAY镇静评分,机械通气时间、ICU住院时间及28d病死率进行统计分析。结果:DS组85例,MS组85例,DMS组88例,机械通气患者镇痛评分DS组(1.07±0.72),MS组(1.04±0.76),DMS组(0.91±0.74),各组差异无统计学意义(P>0.05),镇静评分右美托咪定组(3.04±0.66)低于咪达唑仑组(4.14±0.82)及右美联合咪达唑仑组(4.75±0.65)(P<0.05)。三组患者机械通气时间及ICU住院时间存在显著差异,以右美托咪定镇静组的时间最短(4.75±2.97)(5.47±3.18),右美托咪定联合咪达唑仑组机械通气时间最长(8.59±5.94)(9.67±6.02),差异显著(P<0.05)。28d病死率以咪达唑仑组最高(47.06%),右美托咪定组28d病死率最低(17.65%),差异显著(P=0.000)。结论:不同的镇静方法对AECOPD患者的预后有影响,右美托咪定用于AECOPD患者的镇静具有优势,有利于达到早期轻度镇静的目标。Objective To study the effect of different sedation methods on the prognosis of patients with AECOPD respiratory failure.Methods 258 AECOPD patients with whir failure who were resuscitated in ICU of our hospital from March 2015 to May 2018 were selected as study subjects.According to different sedatives,the eligible patients were randomly divided into 3 groups,namely midazolam+sufentanil(MS)group,dexmedetomidine+Sufentanil(DS)group and dexmedetomidine+midazolam+Sufentanil(DMS)group for analysis.Collected the clinical data of patients with all involved in the research,the gender,age,into the ICU24hⅡacute physiology and chronic health evaluation system(APACHEⅡ)score,CPOT pain score,RASS or RAMSAY sedation score,mechanical ventilation time and ICU length of hospital stay and 28 d case fatality rate were analyzed.Results There were 85 patients in the DS group,85 patients in the MS group,and 88 patients in the DMS group.The analgesic scores of mechanical ventilation patients in the DS group(1.07±0.72),MS group(1.04±0.76),and DMS group(0.91±0.74)had no statistical significance(P>0.05).The sedative score of dexmedetomidine group(3.04±0.66)was lower than that of the midazolam group(4.14±0.82)and that of the dexmedetomidine combined with midazolam group(4.75±0.65)(P<0.05).There were significant differences in mechanical ventilation time and length of stay in ICU among the three groups.The duration of mechanical ventilation was shortest(4.75±2.97)(5.47±3.18)in the dexmedetomidine sedation group,and longest(8.59±5.94)(9.67±6.02)in the dexmedetomidine combined with midazolam group,with statistically significant differences(P<0.05).The case fatality rate was highest in midazolam group(47.06%)and lowest in dexmedetomidine group(17.65%)on 28 days,with statistically significant difference(P=0.000).Conclusion Different sedation methods have an impact on the prognosis of PATIENTS with AECOPD,and dexmedetomidine for sedation of patients with AECOPD has advantages,which is beneficial to achieve the goal of early mild s

关 键 词：AECOPD 机械通气 镇痛镇静 预后 

分 类 号：R563.8[医药卫生—呼吸系统]