右美托咪定结合每日唤醒镇静在机械通气患者中的应用

Influence of daily sedative interruption by on mechanical ventilation patients

目的观察使用右美托咪定结合每Et唤醒的镇静策略对机械通气患者的影响。方法60例ICU气管插管机械通气患者随机分成三组（M组、M＋I组、D＋I组），每组20例，分别使用咪达唑仑持续镇静、咪达唑仑结合每日唤醒镇静、右美托咪定结合每日唤醒镇静，观察三组的机械通气时间、拔管时间（指从开始用药到拔出气管导管）、ICU住院时间（指从开始用药到离开ICU病房的天数）、总住院时间、心血管并发症（心动过缓发生率以及需要干预的心动过缓发生率）、住院病死率。结果与M组比较，M＋I组机械通气时间、拔管时间、ICU住院时间分别缩短1．7、1．7、1．6d（P〈0．05），D＋I组缩短2．9、2．8、2．4d（P〈0．01）；与M＋I组比较，D＋I组平均缩短1．2、1．1、0．8d（P〈0．05）。与M组及M＋I组比较，D＋I组心动过缓发生率明显升高（P〈0．05）。与M组比较，M＋I组及D＋I组住院病死率有所下降（P〈0．05）。结论对气管插管机械通气患者使用右美托咪定结合每日唤醒的镇静较咪达唑仑镇静安全、有效，能明显缩短机械通气时间、ICU住院时间，并降低病死率。

Objective To observe the influence of daily sedative interruption by Dexmedetomidine compared with midazolam on mechanical ventilation patients. Methods Sixty patients with mechanical ventilation were randomly divided into three group for sedation. They were Midazolam group（M group）, Midazolam and daily interruption group （M ＋ I group）, Dexmedetomidine and daily interruption group （ D ＋ I group）. Time of mechanical ventilation, time to extubation, ICU length of stay, incidence of bradycardia, incidence of bradycardia with intervention, hospital mortality were recorded. Results Compared with the M group, the median time of mechanical ventilation, time to extubation, ICU length of stay in M ＋ I group and D ＋ I group was significantly shortened ; these indexes were shortened by 1.7 days, 1.7 days and 1.6 days, respectively in M ＋ I group （ P 〈 0.05 ） and were shortened by 2.9 days, 2.8 days and 2.4 days, respectively in D ＋ I group （ P 〈 0.05）. Compared with the M ＋ I group, the median time of mechanical ventilation, time to extubation, ICU length of stay was significantly shortened in D ＋ I group by 1.2 days, 1.1 days and 0. 8 days, respectively （P 〈 0.05 ）. Compared with M group, the hospital mortality rate in M ＋ I group and D ＋ I group was decreased with a statistically significant difference （P 〈 0.05）. Compared with M Group and M ＋ I group, incidence of bradycardia was increased with a statistically significant difference （P 〈 0.05 ）. Conclusion Daily sedative interruption by Dexmedetomidine is safety and effective compared with midazolam on mechanical ventilation patients.