右美托咪定在主动脉夹层术前低氧血症未行机械通气患者中的应用

The application of Dexmedetomidine in the preoperative hypoxemia in patients with aortic dissection

目的 观察右美托咪定在主动脉夹层术前低氧血症患者中应用的临床效果.方法 我院2012年1月至2013年7月入院诊断急性主动脉夹层（AAD）243例,其中Standford A型104例、Standford B型139例.按是否使用右美托咪定分为右美托咪定组和对照组,观察其临床情况,统计CRP、细胞因子、血沉、白细胞总数及中性粒细胞分类、BNP等炎性因子,需机械通气辅助的例数,住院时间,以及是否出现二氧化碳潴留情况.结果 243例AAD患者中发生低氧血症145例,按是否使用右美托咪定分为两组,右美托咪定组68例,对照组77例.右美托咪定组患者使用右美托咪定后各项炎性指标（IL-6,IL-8,TNF-α等）较前均有所下降,与对照组比较差异有统计学意义（P＜0.05）,并缩短了住院时间[Standford A型（17.0±13.8）d比（19.9±16.2）d,P＜0.05;Standford B型（15.0±9.8）d比（18.6±11.2）d,P＜0.05],不引起明显二氧化碳潴留（t=0.454,P＞0.05）,改善了患者人住监护室后的治疗依从性,做到“清醒镇静”.结论 使用右美托咪定可改善主动脉夹层尚未手术治疗患者因低氧血症引起的烦躁、胸部不适甚至谵妄症状,降低炎性反应,减少需机械通气的例数,缩短住院时间,且无明显呼吸抑制,不加重低氧血症,无明显临床并发症.

Objective To investigate the application of Dexmedetomidine in the preoperative hypoxemia in patients with aortic dissection. Methods Between 2012 January to 2013 July, 243 cases of acute aortic dissec- tion （AAD） patients were observed, including 104 cases of Standford A type and 139 cases of Standford B type. All the patients were divided into two groups according to the usage of Dexmedetomidine or not. The C-reaction protein（CRP） level, cytokines level, erythrocyte sedimentation rate（ESR）, white blood cell count and classifica- tion of neutrophils, inflammatory cytokines level, mechanical ventilation ratio, hospitalization days and Carbon dioxide retention ratio were analyzed between the two groups. Results The total number of hypoxemia were 145 cases, 68 cases in the Dexmedetomidine group and 77 cases in the control group. The inflammatory cytokines （IL-6, IL-8, TNF-α and so on ） level of the Dexmedetomidine group was reduced after treatment and the difference were significant to the control group. The using of Dexmedetomidine can reduce hospitalization days [ （17.0±13.8）d vs （19.9±16.2）d between Standford A type, P〈0.05, （15±9.8）d vs （18.6±11.2）d between Standford type, P〈 0.05 ], improve the compliance of patients, and may not cause Carbon dioxide retention. Conclusion The using of Dexmedetomidine in the preoperative hypoxemia in patients with aortic dissection can reduce inflammation reac- tion, decrease mechanical ventilation ratio and shorten hospitalization days without obvious clinical complications.