右美托咪定治疗ICU呼吸机相关性肺炎的疗效  

Effect of dexmedetomidine treatment of ICU patients with ventilator-associated pneumonia

作　　者：林秋香 李雨晴 王小莉 王诗淞 王光权 LIN Qiu-xiang;LI Yu-qing;WANG Xiao-li;WANG Shi-song;WANG Guang-quan(Qionghai People's Hospital,Qionghai,Hainan 571400,China)

机构地区：[1]琼海市人民医院药学部,海南琼海571400 [2]琼海市人民医院ICU,海南琼海571400

出　　处：《中华医院感染学杂志》2022年第15期2274-2278,共5页Chinese Journal of Nosocomiology

基　　金：海南省科研基金资助项目(2019-1412)。

摘　　要：目的探究右美托咪定在重症监护病房(ICU)呼吸机相关性肺炎(VAP)患者中的应用。方法选取2019年12月-2020年12月于琼海市人民医院ICU病房接受气管插管机械通气治疗并发生VAP的患者97例,随机数表法分为右美托咪定组(n=51)和对照组(n=46)。两组患者均接受常规对症治疗及综合干预护理,右美托咪定组在此基础上加用右美托咪定。比较两组患者确诊时(T0)、治疗后72 h(T1)和治疗后96 h(T2)的呼吸力学指标、动脉血气指标、血清炎性因子、单个核细胞Toll样受体/核因子κB(TLRs/NF-κb)信号通路表达情况、痰液黏蛋白5AC(MUC5AC)和血清超氧化物歧化酶(SOD)水平。结果T1、T2时间点,右美托咪定组的呼气末正压(PEEP)、气道平台压(Pplat)和气道峰压(PIP)水平均低于对照组(P<0.05),动脉血氧合指数(PaO_(2)/FiO_(2))均高于对照组(P<0.05)。T1、T2时间点,右美托咪定组的白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)、TLR2、TLR4、NF-κb蛋白和痰液MUC5AC表达水平均低于对照组(P<0.05),血清SOD水平高于对照组(P<0.05)。结论右美托咪定在治疗VAP方面疗效确切,能有效改善患者的呼吸水平和肺部氧合情况,其机制可能与右美托咪定降低炎性因子水平、抑制TLRs/NF-κb信号通路激活、下调MUC5AC表达、改善氧化应激状态等有关。OBJECTIVE To investigate the application of dexmedetomidine in ICU patients with ventilator-associated pneumonia(VAP).METHODS A total of 97 patients with VAP who received tracheal intubation mechanical ventilation in ICU of Qionghai People’s Hospital from Dec 2019 to Dec 2020 were recruited.The patients were divided into the dexmedetomidine group(n=51)and control group(n=46)by random number table method.Patients in both groups received conventional symptomatic treatment and comprehensive intervention nursing,dexmedetomidine was additionally administered in dexmedetomidine group on this basis.The respiratory mechanical indexes,arterial blood gas indexes,serum inflammatory factors,expressions of Toll-like receptors/nuclear factor-KB(TLRs/NF-κb)signal pathway,sputum mucin 5 AC(MUC5 AC)and serum superoxide dismutase(SOD)levels were compared between the two groups at diagnosis(T0),72 h after treatment(T1)and 96 h after treatment(T2).RESULTS At T1 and T2,the positive end expiratory pressure(PEEP),plateau pressure(Pplat)and peak inspiratory pressure(PIP)in the dexmedetomidine group were significantly lower than those in the control group(P<0.05),while the arterial blood oxygenation index(PaO_(2)/FiO_(2))was significantly higher than that in the control group(P<0.05).At T1 and T2,the levels of interleukin-6(IL-6),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),protein expression levels of TLR2,TLR4 and NF-κb,and the expression level of sputum mucin MUC5 AC in the dexmedetomidine group were significantly lower than those in the control group(P<0.05),while serum SOD level was significantly higher than that in the control group(P<0.05).CONCLUSION Dexmedetomidine is effective in the treatment of VAP,which can effectively improve the patient’s respiratory level and pilmonary oxygenation.The mechanism may be related to the reduction of inflammatory factors,inhibition of TLRs/NF-κB signaling pathway activation,down-regulation of MUC5 AC expression,and improvement of oxidative stress state.

关 键 词：ICU呼吸机相关性肺炎 右美托咪定 TLRs/NF-κb信号通路 黏蛋白5AC 超氧化物歧化酶 疗效 

分 类 号：R563.1[医药卫生—呼吸系统]