右美托咪啶用于慢性阻塞性肺疾病患者机械通气时镇静效果分析

A analysis of efficacy of sedation with dexmedetomidine in patients with chronic obstructive pulmonary disease undergoing mechanical ventilation

目的 研究右美托咪啶用于慢性阻塞性肺疾病患者机械通气时镇静效果。 方法 入选病例来自2012年1月-2015年11月在济宁医学院附属医院重症医学科收治的慢性阻塞性肺疾病急性发作合并呼吸衰竭行机械通气患者60例；采取前瞻随机对照方法分为两组右美托咪定组和咪达唑仑组，每组30例，记录两组的APACHEII评分、Ramsay评分等指标，比较两组患者机械通气时间，ICU住院时间，低血压、心动过缓、谵妄发生率。结果 右美托咪啶组机械通气时间95±5h与咪达唑仑组通气时间126±6h相比，t=16.65 、P＜0.01；右美托咪啶组ICU住院时间6.1±1.5d与咪达唑仑组ICU住院时间8.2±1.7d相比，t=9.34、 P＜0.01。右美托咪啶组谵妄发生率与咪达唑仑组发生率相比（X2=12.17、P＜0.01）＝差异有统计学意义。低血压和心动过缓的发生率差异无统计学意义（P〉0．05）。 结论 右美托咪定用于慢性阻塞性肺疾病患者机械通气镇静治疗是有效的，它能缩短机械通气时间及住ICU时间，能降低谵妄发生率。

Objective To investigate the sedative effects of dexmedetomidine in Patients with chronic obstructive pulmonary disease undergoing mechanical ventilation.Methods Admitted cases are from Sixty patients of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure undergoing mechanically ventilated in the intensive care unit（ICU）from January 2012 to November 2015,For this randomized controlled trial,60 cases were were randomly divided into 2 groups：dexmedetomidine group and midazolam group,each group30 cases,APACHEⅡscore、ramsay score were recorded ,The time of mechanical ventilation 、the time of the intensive care unit（ICU）、 hypotension、bradyeardia and Delirium were compared. Results The time of mechanical ventilation in dexmedetomidine group95±5h are Compared with The time of mechanical ventilation in midazolam group126±6h, t=16.65、 P〈0.01; the time of the intensive care unit in dexmedetomidine group6.1±1.5d are Compared with the time of the intensive care unit in midazolam group8.2±1.7d, t=9.34、 P〈0.01, the incidence of delirium in dexmedetomidine group compared with midazolam group has intergroup differences existed （X2=12.17、P〈0.01）.No intergroup differences existed in the incidence of hypotension and bradyeardia（P〉0.05） .Conclusion Sedative effects of dexmedetomidine are effective for chronic obstructive pulmonary disease undergoing mechanical ventilation.It can reduce the time of mechanical ventilation and the intensive care unit（ICU） staying time, and decrease the incidence of delirium..