右美托咪定在急性左心衰竭患者行NIPPV治疗中的作用研究

Effect of dexmedetomidine on acute left heart failure patients treated with NIPPV

目的:将右美托咪定应用于急性左心衰竭行无创正压机械通气(NIPPV)治疗的患者,探讨其安全性及有效性。方法:回顾性分析2016年1月-2017年6月入住我院心内科CCU的76例患者的临床资料。所有患者均行NIPPV治疗,根据是否静脉泵入右美托咪定镇静,分为对照组(31例)和观察组(45例)。治疗24 h后观察患者基本生命体征,收集血气分析及心功能数据,总结临床预后指标。结果:治疗24 h后,观察组患者呼吸频率(RR)和心率(HR)较对照组更慢(P<0.05),但2组平均动脉压(MAP)比较差异无统计学意义(P>0.05)。血气分析结果提示,观察组患者的动脉血氧饱和度(SO2)及动脉血氧分压(PaO2)显著升高(P<0.05),动脉血二氧化碳分压(PaCO2)及乳酸(Lac)水平显著下降(P<0.05)。进一步利用心脏彩超评估患者的心功能,发现与对照组比较,观察组患者的心输出量(CO)及心脏指数(CI)显著提高(P<0.05),而2组左室射血分数(LVEF)比较差异无统计学意义(P>0.05)。与对照组比较,观察组患者氨基末端脑钠肽前体(NT-proBNP)值及谵妄发生率更低(P<0.05),其机械通气时间也显著降低(P<0.05)。结论:将右美托咪定用于行NIPPV治疗的急性左心衰竭患者是一项安全有效的镇静方案,值得进一步推广。

Objective:We apply dexmedetomidine to acute left heart failure patients treated with non-invasive positive pressure ventilation(NIPPV)to explore its safety and effectiveness.Method:A total of 76 patients admitted to the cardiology department CCU of our hospital from January 2016 to June 2017,who were all treated with NIPPV,were retrospectively analyzed.Patients were divided into control group(n=31)and observation group(n=45)according to whether intravenous infusion of dexmedetomidine sedation was performed.After treatment for 24 h,patients’basic vital signs were observed,blood gas analysis and cardiac function data were collected,and clinical outcomes were summarized.Result:After 24 h,patients in the observation group had slower respiratory rate and heart rate(P<0.05),but similar mean arterial pressure(P>0.05)to those in control group.The results of blood gas analysis suggested that SO2 and PaO2 in the observation group were significantly increased(P<0.05),while the levels of PaCO2 and lactic acid were significantly decreased(P<0.05).Echocardiography showed that dexmedetomidine significantly improved the cardiac output and cardiac index of the patients(P<0.05)but had no effect on the left ventricular ejection fraction(P>0.05).Compared with control group,observation group had lower NT-proBNP values and incidence of delirium(P<0.05),and its mechanical ventilation time was also significantly reduced(P<0.05).Conclusion:The use of dexmedetomidine in NIPPV patients with acute left heart failure is a safe and effective sedation regimen and deserves further promotion.