重症监护室机械通气严重脓毒症患者右美托咪定应用镇静镇痛效果  

Effect of dexmedetomidine on sedation and analgesia of intensive care unit severe sepsis patients undergoing mechanical ventilation

作　　者：赵昆 马宾 王纪明 任燕 薛迎昌 ZHAO Kun;MA Bin;WANG Ji-ming;REN Yan;XUE Ying-chang(Affiliated People's Hospital of Shandong First Medical University,Jinan,Shandong 271100,China)

机构地区：[1]山东第一医科大学附属人民医院麻醉科,山东济南271100 [2]山东第一医科大学附属人民医院疼痛科,山东济南271100 [3]山东第一医科大学附属人民医院重症监护室,山东济南271100

出　　处：《中华医院感染学杂志》2024年第21期3221-3225,共5页Chinese Journal of Nosocomiology

基　　金：山东省医学会舒适化医疗科研基金资助项目(YXH2020ZX037)。

摘　　要：目的探讨重症监护室机械通气严重脓毒症患者右美托咪定(Dex)应用镇静镇痛效果。方法研究对象选自2020年7月-2023年7月在山东第一医科大学附属人民医院接受治疗的机械通气严重脓毒症患者,共纳入92例,随机数字表法分为A组和B组,每组例数均为46例。A组和B组分别给予咪达唑仑、Dex主导的早期目标导向镇静方案治疗。两组术后均随访7 d。比较两组镇静达标情况及转归指标,术前、术后1 d的炎症指标,术前、术后3 d的肠屏障功能,随访期间的不良事件及多器官功能不全综合征(MODS)发生率。结果B组镇静达标率高于A组(P<0.05);B组镇静达标时间长于A组,停药后苏醒、机械通气及重症监护室(ICU)留住的时间均短于A组(P<0.05)。与术前比较,术后1 d,两组血清炎症指标水平均降低(P<0.05),且与A组比较,B组更低(P<0.05)。与术前比较,术后3 d,两组血清肠屏障功能相关指标水平均降低(P<0.05),且与A组比较,B组更低(P<0.05)。随访期间,B组不良事件发生率及MODS发生率均低于A组(P<0.05)。结论Dex主导的早期目标导向镇静方案镇静效果良好,可有效改善机械通气严重脓毒症患者疾病转归指标,且可减轻患者炎症反应,提高患者肠屏障功能,降低MODS发生率,安全性较高,但可能延长患者镇静达标时间。OBJECTIVE To explore the effect of dexmedetomidine(Dex)on sedation and analgesia of intensive care unit(ICU)severe sepsis patients undergoing mechanical ventilation.METHODS A total of 92 patients with mechanically ventilated severe sepsis who were treated in Affiliated People′s Hospital of Shandong First Medical University from Jul.2020 to Jul.2023 were recruited as the research subjects and were randomly divided into the group A and the group B,with 46 cases in each group.The group A was treated with midazolam,and the group B was given the early goal-oriented sedation regimen led by Dex.A 7-day follow-up was conducted for the two groups after the surgery.The passing rate of sedation and treatment outcome indexes were compared between the two groups,the inflammatory indexes were compared before the surgery and after the surgery for 1 day,the intestinal barrier function indexes were compared before the surgery and after the surgery for 3 days.The incidence rates of adverse events and multiple organ dysfunction syndrome(MODS)were observed and compared between the two groups during the follow-up.RESULTS The rate of reaching the standard of sedation was higher in the group B than in the group A(P<0.05).The time of reaching the standard of sedation was longer in the group B than in the group A;the time interval between drug withdrawal and awakening,mechanical ventilation duration and length of intensive care unit(ICU)stay were shorter in the group B than in the group A(P<0.05).The levels of serum inflammatory indexes of the two groups were lower after the surgery for 1 day than before the surgery(P<0.05),and the levels of the above indexes of the group B were lower than those of the group A(P<0.05).The levels of serum intestinal barrier function indexes of the two groups were lower after the surgery for 3 days than before the treatment(P<0.05),and the levels of the above indexes of the group B were lower than those of the group A(P<0.05).The incidence rates of adverse events and MODS of the group B were lower than t

关 键 词：脓毒症 机械通气 右美托咪定 肠屏障功能 多脏器功能不全综合征 

分 类 号：R631[医药卫生—外科学]