床旁超声评估右美托咪定镇静对机械通气患者胃肠功能的影响  

Effect of dexmedetomidine sedation on gastrointestinal function in patients with mechanical ventilation by bedside ultrasound

作　　者：朱满意[1] 韦正祥[1] 李明新 ZHU Manyi;WEI Zhengxiang;LI Mingxing(Department of ICU,the First Hospital of Chu Zhou,Anhui,239000,China)

机构地区：[1]滁州市第一人民医院ICU,安徽滁州239000

出　　处：《临床急诊杂志》2021年第5期309-313,共5页Journal of Clinical Emergency

摘　　要：目的:探讨右美托咪定镇静对重症监护病房机械通气患者胃肠功能的影响及床旁超声在评估胃动力过程中的价值。方法:气管插管接受机械通气并给予镇静治疗的60例重症患者,按照随机数字表法分为观察组和对照组各30例,两组均充分镇痛并接受常规治疗。观察组以右美托咪定镇静,对照组以咪达唑仑镇静。治疗过程中行超声胃动力检查,比较两组患者胃窦收缩频率(ACF)、胃窦收缩幅度(ACA)、胃窦运动指数(MI)、胃排空速率(GER)及胃残余量(GRV)水平。比较两组患者机械通24 h(T24)及48 h(T48)腹内压(IAP)水平。对比两组患者肠内营养开始时间、肠内营养达标率、气管插管拔管率、机械通气时间。比较两组患者治疗过程中出现呕吐、腹泻、消化道出血等消化系统并发症的情况。结果:与对照组相比较,观察组胃窦收缩频率、胃窦收缩幅度、胃窦运动指数、胃排空速率增加,胃残余及腹内压水平下降,差异有统计学意义(P<0.05或0.01)。观察组患者肠内营养开始时间明显早于对照组(P<0.05),肠内营养达标率及气管插管拔管率显著高于对照组(P<0.05),机械通气时间显著短于对照组(P<0.05)。观察组患者消化系统并发症发生率较对照组明显降(P<0.05)。结论:对机械通气患者实行镇静治疗,与咪达唑仑相比较,右美托咪定可改善胃肠功能,提高患者气管插管拔管率、缩短机械通气时间,减少消化系统并发症发生率,超声可作为评估胃动力功能的客观辅助检查。Objective: To evaluate the effect of dexmedetomidine sedation on gastrointestinal function of patients with mechanical ventilation(MV) in ICU and the value of bedside ultrasound in evaluation of gastric motility. Methods: Sixty critical patients with MV treatment were randomly divided into observation group and control group with thirty cases in each group. The two groups were received moderate analgesia and routine treatment, the observation group was sedated with dexmedetomidine, while the control group was sedated with midazolam. During the treatment, gastric motility was examined by ultrasound. The levels of antral contraction frequency(ACF), antral contraction amplitude(ACA), motility index(MI), gastric emptying rate(GER) and gastric residual volume(GRV) were compared between the two groups. The intra-abdominal pressure(IAP) levels at 24 h(T24) and 48 h(T48) after mechanical ventilation were compared between the two groups. The start time of enteral nutrition(EN), standard-reaching rate of EN, the extubation rate of tracheal intubation and the time of MV were compared between the two groups. The complications of digestive system such as vomiting, diarrhea and gastrointestinal bleeding were compared between the two groups. Results: Compared with the control group, the ACF, ACA, MI and GER in the observation group increased, while the level of GRV and IAP decreased(P<0.05 or 0.01). The start time of EN in the observation group was significantly earlier than that in the control group(P<0.05). The standard-reaching rate of EN and the extubation rate of tracheal intubation were significantly higher than that of the control group(P<0.05). The duration of MV in the observation group was significantly shorter than that of the control group(P<0.05). The incidences of digestive complications in the observation group were significantly lower than that of the control group(P<0.05). Conclusion: Compared with midazolam, dexmedetomidine can improve gastrointestinal function, improve the rate of tracheal extubation, shorten

关 键 词：床旁超声 机械通气 胃肠功能 右美托咪定 咪达唑仑 

分 类 号：R459.7[医药卫生—急诊医学]