右美托咪啶对慢性阻塞性肺疾病急性加重期应用无创呼吸机患者的临床疗效

Application of dexmedetomidine hydrochloride in sedation practices during NPPV for patients with acute exacerbations of COPD

目的观察右美托咪啶对慢性阻塞性肺疾病急性加重期应用无创呼吸机患者的临床疗效。方法将我院急诊重症监护室2014年3月-2015年4月收治的60例慢性阻塞性肺疾病急性加重期应用无创呼吸机的患者随机分成对照组30例,试验组30例。两组均给予常规治疗及无创呼吸机应用。试验组加用右美托咪啶镇静,先给予负荷量0.8μg/kg静推,持续约10min,后给予维持剂量0.2-1.0μg·-1kg·h-1泵入,按照镇静评分Ramsay2-4分达标来调整用药剂量。比较两组患者2h、8h、12h、24h的心率、呼吸、平均动脉压、PaO2、PaCO2、pH值、插管率、待机时间、住院天数。结果对照组中改用有创呼吸机辅助呼吸5例,插管率16.67%;实验组中2例,插管率6.67%。实验组中出现心动过缓1例,药物减量后恢复。两组2h、8h、12h、24h的心率、呼吸、平均动脉压、PaO2、PaCO2、pH值差异有统计学意义,P〈0.05。两组的待机时间、住院天数差异具有统计学意义,P〈0.05。结论慢性阻塞性肺疾病急性加重期患者应用无创呼吸机时给予右美托咪啶镇静安全,可减少待机时间,减少患者住院天数。

Objective To investigate the effect of dexmedetomidine hydrochloride in sedation practices during noninvasive ventilator for patients with acute exacerbation of COPD（AECOPD）. Methods 60 patients with AECOPD and respiratory failure,admitted in EICU between Mar 2014 and Apr 2015, were randomly divided into observation group and control group. All patients received conventional treatment and noninvasive ventilator.Meanwhile in the observation group,dexmedetomidine hydrochloride（0.8μg/kg） was intravenously injected within 10 minutes,then maintained at 0.2-1.0μg·kg-1·h-1by a micropump to maintain Ramsay Sedation Scale score ranged from 2 to 4. The patients＇ noninvasive ventilator day 、 endotracheal intubation rate and hospital stay were compared between two groups.Heart rate,mean arterial pressure,respiratory rate,PaO2,Pa CO2 and p H 2h,8h,12 h and 24 h after treatment were also compared. Results The endotracheal intubation rate of control group was 16.67%; endotracheal intubation rate of observation group was 6.67%. 1 case occured bradycardia in the observation group and recovered with dosage reduction. Heart rate,mean arterial pressure,respiratory rate,PaO2,Pa CO2 and p H,noninvasive ventilator day,hospital stay were all improved in two groups（P〈0.05）. Conclusion Dexmedetomidine hydrochloridemay was served as a safe and effective sedative drug during noninvasive ventilator in patients with AECOPD, which can reduce noninvasive ventilator day and hospital stay.