右美托咪定在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者无创通气中的应用

Application of Dexmedetomidine Hydrochloride in Sedation Practices during NPPV for Patients with Acute Exacerbations of COPD and Respiratory Failure

目的探讨右美托咪定在慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者无创正压通气(NPPV)中的治疗作用。方法 2011年1月至2012年4月宁海第一医院重症医学科收治的AECOPD合并呼吸衰竭患者50例,随机分为观察组和对照组,每组25例。两组均给予内科常规药物治疗及NPPV,观察组在上述治疗的同时给予右美托咪定注射液1μg/kg,于10 min内静推毕后,采用微量泵静推,以0.1～0.6μg·kg-1·h-1剂量维持,以镇静Ramsay评分2～4分为目标调整剂量。比较两组患者治疗前、后24 h的心率、平均动脉压、呼吸频率、动脉血气(pH值、PaO2、PaCO2),以及对NPPV的依从性(改有创通气率)和住ICU时间。结果两组患者治疗后心率、平均动脉压、呼吸频率、动脉血气均较治疗前明显改善(P<0.05),观察组治疗后上述指标较对照组改善更明显(P<0.05)。观察组对NPPV的依从性明显优于对照组,有创通气率[4%比16%]和住ICU时间[(5.47±3.19)d比(8.78±3.45)d]显著降低(P<0.05)。结论右美托咪定应用于AECOPD合并呼吸衰竭患者NPPV时有良好的疗效,可作为ICU内AECOPD患者NPPV时安全有效的镇静药物。

Objective To investigate the feasibility of dexmedetomidine hydrochtoride in sedation practices during NPPV for patients with acute exacerbation of COPD （AECOPD） and respiratory failure. Methods 50 patients with AECOPD and respiratory failure, admitted in ICU between January 201! and April 2012,were divide into an observation group and a control group. All patients received conventional treatment and noninvasive positive pressure ventilation （NPPV）. Meanwhile in the observation group, dexmedetomidine hydrochloride （1 I^g/kg） was intravenously injected within 10 minutes, then maintained using a micropump by 0. 1 -0. 6lxg ＂ kg- 1 . h -1 to maintaining Ramsay Sedation Scale （RSS） score ranged from 2 to 4. The patients＇ compliance to NPPV treatment （conversion rate to invasive ventilation） and ICU stay were compared between two groups. Heart rate, mean arterial pressure, respiratory rate, and arterial blood gas （pH, PaO2 ,PaCO2 ） before and 24 hours after treatment were also compared. Results After 24 hours treatment, heart rate, mean arterial pressure, respiratory rate, and arterial blood gas were all improved in two groups,while the improvements were more remarkable in the observation group. The conversion rate to invasive ventilation （4% vs. 16% ）and ICU stay [ （5.47 ＋3. 19）d vs. （8.78 ＋3.45）d] were lower in the observation group than those in the control group. （P 〈 0.05 ）. Conclusion Dexmedetomidine hydrochloride may serve as a safe and effective sedative drug during NPPV in patients with AECOPD and respiratory failure.