右美托咪定、咪达唑仑和丙泊酚对ICU严重创伤患者谵妄发生的影响  

Effects of dexmedetomidine,midazolam and propofol on the occurrence of delirium in patients with severe trauma in Intensive Care Unit

作　　者：裴兴华[1] 吴艳红[1] 李志平 李玉姬 周煦[1] 于海明[1] Pei Xinghua;Wu Yanhong;Li Zhiping;Li Yuji;Zhou Xu;Yu Haiming(Department of critical care medicine,Hunan provincial peopel's hospilal,Changsha,Hunan,China.)

机构地区：[1]湖南省人民医院重症医学科

出　　处：《实用休克杂志（中英文）》2020年第6期334-337,共4页Journal of Practical Shock

基　　金：湖南省卫生计生委科研计划课题项目(项目编号:B2017090)。

摘　　要：目的探讨右美托咪定、咪达唑仑和丙泊酚对ICU严重创伤患者谵妄发生的影响。方法以湖南省人民医院ICU收治的123例接受有创机械通气的严重创伤患者(新损伤严重度评分(new Injury severity score,NISS)≥16分)为研究对象,男78例,女45例,年龄20~70岁,按随机数字表法分成右美托咪定组、咪达唑仑组和丙泊酚组,每组41例。各组均使用芬太尼镇痛,维持CPOT目标疼痛评分1~2分、维持RASS目标镇静评分-2~0分。患者行机械通气后每4h评估是否发生谵妄,最长评估7d。结果三组患者的年龄、性别、体重和NISS评分相比无统计学差异(P>0.05)。相比于咪达唑仑组发生数(13例,31.70%),或丙泊酚组发生数(12例,29.27%),右美托咪定组谵妄发生数为7例(17.07%),发生数量和发生率明显减少(P<0.05);右美托咪定组首次谵妄发生时间为54.43±10.88h,相比咪达唑仑组(27.31±12.66h)或丙泊酚组(31.33±13.20h)明显推迟,差异统计学意义(P<0.05),而咪达唑仑组或丙泊酚组两组相比差异无统计学意义(P>0.05);三组患者的机械通气时间分别为6.78±4.22d、6.64±3.89d和6.78±3.63d,三组相比无明显差异(P>0.05);相比于咪达唑仑组(9.96±5.84d)或丙泊酚组(10.17±5.44d),右美托咪定组(7.49±4.58d)在ICU住院时间明显缩短(P<0.05),而咪达唑仑组与丙泊酚组组相比差异无统计学意义(P>0.05)。结论与咪达唑仑和丙泊酚相比,右旋美托咪定预防ICU严重创伤患者谵妄发生的效果更确切,但心动过缓的发生率明显升高,临床中应根据患者的具体情况合理选择镇静药物。Objective To investigate the effects of dexmedetomidine,midazolam and propofol on the occurrence of delirium in patients with severe trauma in ICU.Methods A total of 123 severe trauma patients(new injury severity score,NISS)≥16 who underwent invasive mechanical ventilation were enrolled in the ICU of Hunan Provincial People’s Hospital,including 78 males and 45 females,aged 20~70 years.All patients were divided into dexmedetomidine group,midazolam group and propofol group by random number table method,41 cases were included in each group.All groups used fentanyl analgesia,maintained a CPOT target pain score of 1~2 points,and maintained a RASS target sedation score of-2~0.All patients were assessed for delirium every 4 hours after mechanical ventilation,and the longest evaluation was 7 days.Results There were no significant differences in age,gender,weight and NISS scores among the three groups(P>0.05).Compared with the midazo-lam group(13 cases,31.70%),or propofol group(12 cases,29.27%),the occurrence of dexmedetomidine group(7 cases,17.07%)was significantly reduced(P<0.05).The first delirium occurrence time was 54.43±10.88 hours in the dexmedetomidine group,which was significantly delayed compared with the midazolam group(27.31±12.66 hours)or the propofol group(31.33±13.20 hours)(P<0.05),and there was no significant difference between midazolam group and propofol group(P>0.05).The mechanical ventilation time of the three groups They were 6.78±4.22 days,6.64±3.89 days,and 6.78±3.63 days,respectively,and there was no significant difference among the three groups(P>0.05).The dexmedetomidine group(7.49±4.58 days)was significantly shorter in the ICU compared with the midazolam group(9.96±5.84 days)or propofol group(10.17±5.44 days)(P<0.05),and there was no significant difference between midazolam group and propofol group(P>0.05).Conclusions The effect of dexmedetomidine in the prevention and treatment of delirium in ICU severe trauma patients is more accurate than midazolam and propofol,but the incidence

关 键 词：右美托咪定 咪达唑仑 丙泊酚 严重创伤 谵妄 

分 类 号：R614[医药卫生—麻醉学]