多发伤患者实施每日唤醒时氧化应激指标变化的研究

The clinical study of daily interruption of sedation on the indicators of oxidative stress for critically ill patients undergoing multiple trauma

目的:观察多发伤患者实施每日唤醒时氧化应激指标的变化,探讨每日唤醒对多发伤患者氧化应激反应的作用机制。方法:选取我院急诊ICU 2013年2月至2014年5月46例多发伤患者,随机分成常规镇静治疗组(对照组n=20例),每日唤醒组(实验组n=26例),两组患者随机接受丙泊酚或者咪达唑仑,同时合用芬太尼镇痛。分别测定血浆丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、一氧化氮(NO)水平,记录30 d病死率,并对上述指标进行相关分析。结果:两组患者病死率无统计学差异,实验组死亡2例(8%),对照组死亡5例(25%),P=0.228,实验组血浆超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、NO水平高于对照组,分別为:(151.15±37.94)vs.(126.05±36.09),P=0.028;(125.58±38.96)vs.(98.05±33.41),P=0.015;(65.58±15.49)vs.(52.25±16.73),P=0.008。实验组血浆丙二醛(MDA)低于对照组,(5.87±3.30)vs.(8.2±3.91),P=0.034。结论:每日唤醒可以降低多发伤患者氧化应激水平,改善患者预后可能与每日唤醒降低多发伤患者氧化应激水平有关。

Objective： To observe the change of oxidative stress indicators, and to access the mechanism of a protocol for routine daily interruption of sedation （DSI） on oxidative stress response for critically ill patients undergoing multiple trauma. Methods： We conducted a randomized, controlled trial involving 46 adult patients undergoing multiple trauma and continuous infusions of sedative drugs in an emergency intensive care unit from February 2013 to May 2014. Patients were randomly assigned DSI group （the intervention group,n=26） and conventional sedation group （the control group,n=20）. Patients were sedated with propofol or midazolam, both groups were treated with bolus doses analgesic fentanyl. Plasma MDA, SOD, GSH-Px and NO were determined. 30-d mortality was then compared between two groups.Results：hTe mortality of both groups was similar （2 vs. 5,P=0.228）. Plasma SOD （151.15±37.94） vs. （126.05±36.09） （P=0.028）, GSH-Px （125.58±38.96） vs. （98.05±33.41） （P=0.015） and NO （65.58±15.49） vs. （52.25±16.73） （P=0.008） in the intervention group were higher than those in the control group, while plasma MDA （5.87±3.30） vs. （8.2±3.91） （P=0.034） was lower than that in the intervention group.Conclusion：Daily interruption of sedation can reduce the levels of oxidative stress of critically ill patients undergoing multiple trauma, which improving the prognosis of patients may be related with reduce the levels of oxidative stress.