右美托咪啶对ICU机械通气患者睡眠分裂的影响

Dexmedetomidine improves sleep quality of patients with mechanical ventilation

【摘要】目的探讨右美托眯啶对机械通气患者睡眠时间及睡眠分裂的影响。方法将7个ICU中心200例机械通气患者按随机数字表法分为治疗组和对照组，每组各100例，治疗组采用右美托咪啶针镇静0．2～1.2ug／（kg·h），对照组采用咪唑安定针镇静0．05～0．4mg／（kg·h），患者人组后即开始持续泵入实验药物并调节剂量至轻度镇静（Ramsay评分3～4分），直至拔除气管插管或者满14d。应用多导睡眠监测仪（PSG）自晚上22：00至次日凌晨6：00监测患者睡眠时间和睡眠分裂，评价两组患者的机械通气时间、谵妄发生率、意外拔管发生率以及28d生存率。结果在镇静达标情况下治疗组与对照组总睡眠时间和睡眠效率比较差异无统计学意义（P〉0.05）。治疗组的1、2期睡眠所占比例低于对照组，差异有统计学意义（P〈0.05）。治疗组的SWS期、REM期睡眠所占比例高于对照组．差异有统计学意义（P〈0.05）。治疗组与对照组睡眠唤醒、觉醒的次数比较差异有统计学意义（P〈0.05）。治疗组机械通气时间与谵妄发生率明显低于对照组（P〈0.05），而意外拔管发生率与28d生存率两者无统计学差异（P〉0．05）。结论右美托咪啶可以改善机械通气患者睡眠结构，减少睡眠分裂，更接近于自然睡眠状态，或可减少谵妄发生。

Objective To investigate the effects of dexmedetomidine to sleep quality of patients with mechanical ven- tilation. Methods Two hundred patients with mechanical ventilation from 7 intensive care units （ICU） were randomly assigned to receive exmedetomidine （study group,n= 100） or Midazolam （control group, n= 100） for sedation. Appropriate dose（ Dexmedeto- midine 0.2 - 1.2ug/kg .h or Midazolam 0.05 -0.4mg/kg .h）was chosen according to the Ramsay Score （3-4 scores）. Dexmedetomidine or Midazolam in continue venous pump were stopped after extubation or for uninterrupted 14 days. Sleep time and sleep split were monitored with polysomnography （PSG） from lOpm to next 6am. The mechanical ventilation time, inci- dence of delirium, unexpected extubation rate and survival rate at d28 were compared between two groups. Results There were no differences in total sleep time （TST） （249 ± 79 vs 256 ± 82, P 〉0.05） and sleep efficiency（SE） （58 ± 14, 62 ± 13, P 〉0.05） between two groups. Patents in study group had lower proportion of first stage sleep time（S1） （7 ± 2, 11 ± 4, P〈0.05） and sec- ond stage sleep time （S2） （65 ± 10, 79 ± 7, P〈0.05）in TST, but had higher proportion of SWS （11 ± 3, 5 ± 3, P〈0.05） and REM （10 ±4, 4 ±3, P〈0.05） in TST compared to control group. Wake up time （19 ±4, 25 ±9, P〈0.05）, mechanical ventilation time （229 ± 35, 278 ± 42, P〈0.05） and the incidence of delirium in study group were less than those in control group. There were no differences in unexpected extubation rate and survival rate at d28 between two groups. Conclusion Dexmedetomidine can significantly improve the sleep structure, reduce the incidence of sleep split in patients with mechanical ventilation.