右美托咪定在急性呼吸窘迫综合征患者镇静治疗中的疗效观察

Clinical observation of dexmedetomidine in the sedation of ARDS patients

目的观察右美托咪定对接受机械通气治疗的成人呼吸窘迫综合征(ARDS)患者的镇静效果及不良反应发生情况。方法选取重症医学科ARDS患者36例,按随机数字表法分为治疗组18例和对照组18例,在芬太尼镇痛基础上,治疗组给予右美托咪定、对照组给予咪达唑仑镇静治疗,维持RASS评分在+1^-2分,记录2组每日唤醒时间、芬太尼的日平均用量、机械通气时间,并观察谵妄的发生情况。结果 2组患者在年龄、性别、急性生理学和慢性健康状况评分系统评分(APACHEⅡ评分)、诱发ARDS的原发病构成、最初氧合指数等方面比较差异均无统计学意义(P均>0.05),均能达到目标镇静效果,治疗组每日唤醒时间较对照组缩短[(25.94±5.02)min vs.(33.33±5.68)min],芬太尼日用量较对照组减少[(0.93±0.15)mg vs.(1.12±0.15)mg],机械通气时间缩短[(6.53±0.72)d vs.(7.36±0.98)d],以上差异均具有统计学意义(P<0.05);2组谵妄发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定镇静易唤醒,与咪达唑仑比较,有助于减少芬太尼用量及其不良反应发生情况,缩短机械通气时间,有利于减少呼吸机相关性肺炎的发生。

Objective To observe sedative effect and safety of dexmedetomidine for ARDS patients treated with mechanical ventilation. Methods 36 cases of ARDS patients treated with mechanical ventilation were enrolled and divided into two groups randomly. they were treated either with dexmedetomidine or midazolam based on sufficient analgesis by fentanyl,keep RASS score ＋ 1 ^-2. Awaking time,daily doses of fentanyl,the duration time of ventilation,and the delirium incidence were compared between the two groups. Results There was no significant difference in gender proportion,age,acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） score,the causes of ARDS and the prime oxygenation index between the two groups（ all P〉0. 05）. The two groups both had satisfactory sedative analgesic effect. Awaking time[（ 25. 94 ± 5. 02） min vs.（ 33. 33 ± 5. 68） min],daily doses of fentanyl[（ 0. 93 ± 0. 15） mg vs.（ 1. 12 ± 0. 15） mg],and the duration time of ventilation[（ 6. 53 ± 0. 72） d vs.（ 7. 36 ± 0. 98） d] in dexmedetomidine group were significant lower than that in the midazolam group（ P〈0. 05）,but no significant differences were found in the delirium incidence between the two groups. Conclusion Dexmedetomidine is easy to wake up,compared with midazolam,it shows a lower daily doses of fentanyl,and a shorter time of mechanica ventilation,and may reduce the occurrence of ventilator-associated pneumonia.