奥氮平联合右美托咪定在ICU机械通气老年谵妄患者中的效果  

Efficacy of olanzapine combined with dexmedetomidine in treatment of elderly patients with delirium undergoing mechanical ventilation in ICU

作　　者：季春莲[1] 孟建标[1] 沈莹[1] 张微[1] 庞丽莎 徐敏荣 JI Chunlian;MENG Jianbiao;SHEN Ying;ZHANG Wei;PANG Lisha;XU Minrong(Department of Intensive Care Unit,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院重症医学科,杭州310012

出　　处：《浙江医学》2022年第1期68-71,共4页Zhejiang Medical Journal

摘　　要：目的探讨奥氮平联合右美托咪定在ICU机械通气老年谵妄患者中的效果。方法收集2016年1月至2018年12月浙江省立同德医院ICU发生谵妄的机械通气老年患者80例,按随机数字表法分为联合用药组和对照组,每组40例。联合用药组采用奥氮平(起始剂量2.5 mg/晚,根据病情逐渐加量至10 mg)联合右美托咪定[1μg/kg,10 min后按照0.2~0.7μg/(kg·h)微量泵入)],对照组单纯应用右美托咪定(剂量和用法同联合用药组)。比较两组患者谵妄持续时间、机械通气时间、48 h再插管率、ICU住院时间、右美托咪定每日用量及不良事件(低血压、心动过缓)发生情况的差异。结果与对照组比较,联合用药组谵妄持续时间、机械通气时间、ICU住院时间、右美托咪定每日用量均少于对照组,48 h再插管率低于对照组,差异均有统计学意义(均P<0.05)。联合用药组严重低血压发生率、严重心动过缓发生率均低于对照组,差异均有统计学意义(均P<0.05)。结论奥氮平联合右美托咪定治疗ICU机械通气老年谵妄患者能缩短机械通气时间,降低48 h再插管率,缩短ICU住院时间,并减少右美托咪定用量,从而减少低血压、心动过缓等不良事件的发生率。Objective To evaluate the efficacy of olanzapine combined with dexmedetomidine in treatment of elderly delirium patients with mechanical ventilation in ICU.Methods From January 2016 to December 2019,80 elderly patients with delirium undergoing mechanical ventilation in ICU of Tongde Hospital of Zhejiang Province were enrolled in the study.Patients were divided randomly into two groups with 40 patients in each group.Patients in the study group received intravenous dexmedetomidine at a dose of 1μg/kg,after 10 min maintaining micro pumping was given at 0.2-0.7μg/(kg·h),the oral olanzapine was administrated with an initial dose of 2.5 mg/night,which might be gradually increased to 10 mg according to the condition.Patients in the control group were treated with dexmedetomidine alone(the dose was as same as in study group).Duration of delirium,duration of mechanical ventilation,re-intubation rate within 48 h,length of ICU stay,daily dose of dexmedetomidine and occurrence of adverse events(hypotension and bradycardia)were documented and compared between the two groups.Results In the study group,the delirium duration(P<0.01),the mechanical ventilation time(P<0.05),the reintubation rate within 48 h(P<0.05),the length of ICU stay(P<0.05),the daily dose of dexmedetomidine(P<0.05),the incidence of hypotension(P<0.05),and the incidence of bradycardia(P<0.05)were all significantly lower than those in the control group.Conclusion Olanzapine combined with dexmedetomidine has a good therapeutic effect on delirium in elderly patients with mechanical ventilation in ICU.

关 键 词：奥氮平 右美托咪定 谵妄 老年 机械通气 

分 类 号：R614[医药卫生—麻醉学]