右美托咪定对慢性阻塞性肺疾病急性加重期患者的预后影响分析

Impact of Dexmedetomidine on Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

目的研究右美托咪定对慢性阻塞性肺疾病急性加重期患者预后的影响。方法本研究采取前瞻性随机对照研究,对入选该实验的69例呼吸重症监护病房（RICU）的慢性阻塞性肺疾病急性加重期患者随机分为实验组（32例）、对照组（37例）。实验组予以右美托嘧定持续静脉泵入[初始速度0.5μg/（kg·h）],后根据RASS评分调整右美托嘧定用药速度,维持RASS评分0～2分,对照组予以空白对照。对比两组患者入科后12、24、36h动脉血气分析（pH、PaO_2、PaCO_2）、气管插管发生率、RICU入住时间、缓慢性心律失常、低血压、谵妄发生率及28 d病死率。结果两组患者入科后12h血气分析结果、RICU入住时间、28 d病死率比较无统计学差异。实验组24、36 h测定血气分析结果（PaO_2、PaCO_2）优于对照组,实验组低血压、缓慢性心律失常发生率较对照组高,但谵妄发生率低。结论右美托咪定能在一定程度改善慢性阻塞性肺疾病急性加重期患者的肺功能,减少谵妄发生率。

Objective To investigate the impact of Dexmedetomidine on outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease（AECOPD） patients. Methods This study was conducted with prospective randomized trial. Totally 69 patients with AECOPD was enrolled and randomly assigned to two groups： observation group（32 patients） and control group （37 patients）, in the observation group dexmedetomidine was injected by 0.5 μg/（kg·h）, then maintaining the RASS ranged 0-2 by titrating injection speed, the control group was injected by placebo, the incidence of mechanical ventilation,delirium, bradycardia, hypotension, 2g days mortality, length of RICU stay and arterial blood gas（pH, PaO2, PaCOE）in 12, 24, 36 hours after treatment were compared between two groups. Results The length of RICU stay, arterial blood gas（pH, PaO2, PaCO2）in 12 hours and 28 days mortality were no statistic different between two Groups（P〉0.05）, the arterial blood gas（PaO2, PaCO2）in 24, 36 hours after treatment were more better in observation group compared with control group（P〈0.05）, in observation group the incidence of bradycardia, hypotension were higher than control group（P〈0.05）, but not the delirium（P〈0.05）. Conclusion Lung function were improved in AECOPD patients by using dexmedetomidine, and can decrease the incidence of delirium.