右美托咪定对机械通气脓毒症患者腹内压及肠黏膜通透性的影响

Effects of Dexmedetomidine on the intra-abdominal pressure and intestinal permeability in septic patients with mechanical ventilation

目的 探讨右美托咪定（DEX）对需机械通气脓毒症患者腹内压（IAP）及肠黏膜通透性的影响。方法 选取江苏大学附属医院综合ICU 2013年1月-2015年12月住院的需机械通气治疗的腹腔感染患者40例,按随机数字表法将其分为DEX组和咪达唑仑组,每组20例。DEX组予负荷剂量1.0μg/kg,以0.2-0.8μg/（kg·h）的剂量维持;咪达唑仑组予负荷剂量0.05 mg/kg,以0.06-0.2 mg/（kg·h）剂量维持,两组均使Ramsay镇静评分维持在3-4分,分别记录患者镇静治疗前、镇静后24及48 h的IAP水平,并检测血浆D-乳酸含量和二胺氧化酶（DAO）的活性。结果 镇静前两组IAP水平比较差异无统计学意义（P〉0.05）;DEX组于镇静后24及48 h的IAP水平显著低于同时间点咪达唑仑组（P〈0.05）。DEX组24及48 h的D-乳酸含量和DAO活性亦明显低于同时间点咪达唑仑组（P〈0.05）。结论 与咪达唑仑相比,DEX可以更有效地降低机械通气脓毒症患者的IAP,且能有效降低患者肠道黏膜通透性,减少肠道细菌易位,改善肠功能障碍。

Objective To discuss the effects of Dexmedetomidine on the intra-abdominal pressure （IAP） and intestinal permeability in septic patients with mechanical ventilation. Methods A total of 40 septic patients with mechanical ventilation were admitted into the Department of Genernal ICU, the Affiliated Hospital of Jiangsu University between January 2013 to December 2015 were enrolled. They were divided into a Dexmedetomidine group （n=20） and a Midazolam group （n=20） by random number table method. The patients in the Dexmedetomidine group were given a loading dose （1 p.g/kg） and then maintained with 0.2-0.8 μg/（kg·h）, the patients in the Midazolam group were given a loading dose （0.05 mg/kg） and then maintained with 0.06-0.2 mg/（kg·h）, sedation level was assessed by Ramsay score and maintained a score of 3-4. lAP was recorded before sedation at 24 h as well as 48 h after, content of D-lactic acid and ac- tivity of diamine oxidase in serum was detected also. Results IAP in Dexmedetomidine group was significantly lower than that in Midazolam group at 24 h and 48 h （P 〈 0.05）, however, there was no significant differences before sedation （P 〉 0.05）. And the content of D-lactic acid and activity of diamine oxidase in serum in Dexmedetomidine group was obviously lower than that in Midazolam group at 24 h and 48 h （P 〈 0.05）. Conclusion Dexmedetomidine can significantly decrease IAP compared with Midazolam for the septic patients with mechanical ventilation, as well as depress intestinal permeability and relieve sepsis symptom resulted from bacterial translocation.