右美托咪啶联合丙泊酚治疗连续静脉血液置换患者脓毒症感染谵妄的效果观察及药动学研究

Efficacy Observation and Pharmacokinetic Study of Dexmedetomidine Combined with Propofol for Sepsis Infection Deliration in Patients Underwent Continuous Intravenous Blood Replacement

目的:观察右美托咪啶联合丙泊酚用于连续静脉血液置换患者脓毒症感染谵妄的效果,并进行药动学研究。方法:选择连续静脉血液置换脓毒症感染谵妄患者60例,随机分为观察组和对照组各30例。对照组患者给予丙泊酚0.5 mg/kg,观察组患者给予右美托咪啶+丙泊酚。对比分析两组患者的疗效,并研究丙泊酚的药动学参数。结果:观察组丙泊酚的药动学参数消除半衰期(t1/2β)、缓慢分布半衰期(t1/2α)等均短于文献参考值,差异具有统计学意义(P<0.05),而分布速率常数(K21、K13、K10)、中央室分布容积(VC)、全身清除率(CL)、快速分布半衰期(t1/2pi)等与文献参考值比较,差异无统计学意义(P>0.05)。治疗后两组患者谵妄症评分表(ICDSC)评分较治疗前明显下降,差异有统计学意义(P<0.05);观察组下降的幅度大于对照组,但治疗前后两组患者比较差异无统计学意义(P>0.05);观察组患者平均住院时间明显短于对照组,差异具有统计学意义(χ2=6.263 4,P=0.000);对照组患者的不良事件发生率显著高于观察组,差异具有统计学意义(P<0.05)。结论:右美托咪啶联合丙泊酚治疗连续静脉血液置换患者脓毒症感染谵妄的效果良好,可以减少患者住院时间,降低不良反应发生率。

OBJECTIVE：To observe therapeutic efficacy of dexmedetomidine combined with propofol for sepsis infection deliration in patients underwent continuous intravenous blood replacement,and to study pharmacokinetic study. METHODS：60patients with sepsis infection deliration underwent continuous intravenous blood replacement were selected and randomly divided into observation group and control group with 30 cases in each group. Control group was given propofol 0.5 mg/kg,and observation group given dexmedetomidine and propofol. Therapeutic efficacy of 2 groups were analyzed comparatively,and pharmacokinetic parameters of propofol were studied. RESULTS：The pharmacokinetic parameters of propofol as elimination half-life period（t1/2β）,slow distribution half-life period（t1/2α）were shorter than literature reference value,with statistical significance（P〈0.05）,while the distribution rate constants（K21,K13,K10）,the central compartment volume of distribution（VC）,systemic clearance（CL）,rapid distribution half-life period（t1/2pi）had no statistical significance,compared with literature reference value（P〉0.05）. After treatment,ICDSC score of 2 groups were decreased significantly,with statistical significance（P〈0.05）,while the observation group was significantly higher than the control group,with no statistical significance before and after treatment（P〉0.05）;the average hospital stay of observation group was significantly shorter than that of control group,with statistical significance（χ^2=6.263 4,P=0.000）;the incidence of ADR in control group was significantly higher than the observation group,with statistical significance（P〈0.05）. CONCLUSIONS：Dexmedetomidine combined with propofol have good effect on sepsis infection deliration in patients underwent continuous intravenous blood replacement,and can reduce the length of hospital stay and the incidence of ADR.