右美托咪定治疗重症脓毒血症合并急性肺损伤和肾损伤患者的临床研究

Clinical trial of dexmedetomidine in the treatment of severe sepsis patients with acute lung and kidney injury

目的观察右美托咪定对重症脓毒血症合并急性肺损伤和肾损伤患者的临床疗效、炎症因子及肝肾损伤的影响。方法将60例重症脓毒血症合并急性肺损伤和肾损伤患者随机分为对照组30例和试验组30例。2组患者均维持常规治疗。对照组使用丙泊酚注射液进行早期镇静治疗;试验组给予右美托咪定注射液1μg·kg^(-1)·h^(-1)进行早期镇静治疗。2组患者治疗时间均为48 h。记录2组患者机械通气时间、重症监护病房(ICU)入住时间及肾替代治疗(CRRT)持续时间。检测2组治疗前后的血清炎症因子水平及肝肾功能指标。结果对照组的ICU入住时间和CRRT持续时间分别为(96.32±13.51),(61.30±9.85)h;试验组分别为(76.18±11.32),(52.93±9.21)h(P<0.01)。治疗后,试验组和对照组的降钙素原分别为(2.05±0.39),(2.43±0.24)ng·L^(-1);C-反应蛋白分别为(56.36±9.94),(79.91±12.55)ng·L^(-1);白细胞介素-6分别为(78.72±11.33),(92.07±12.55)ng·L^(-1);肿瘤坏死因子-α分别为(17.56±4.07),(24.41±4.25)ng·L^(-1),差异均有统计学意义(均P<0.01)。治疗后,试验组和对照组的谷丙转氨酶分别为(21.37±4.73),(30.46±6.44)U·L^(-1);谷草转氨酶分别为(29.61±6.97),(38.60±7.53)g·L^(-1);碱性磷酸分别为(67.27±7.26),(71.75±8.41)U·L^(-1);总胆红素分别为(11.36±2.91),(14.72±2.29)μmol·L^(-1);尿素氮分别为(7.03±2.03),(10.07±3.12)mmol·L^(-1);血清肌酸酐分别为(87.98±10.56),(123.73±11.74)μmol·L^(-1),差异均有统计学意义(均P<0.05)。2组患者治疗过程中均未出现明显的药物不良反应。结论与丙泊酚相比,右美托咪定对症脓毒血症合并急性肺损伤和肾损伤患者有更好的临床疗效,对脏器的保护作用及炎症因子的改善作用更强。

Objective To observe the influences of dexmedetomidine（ DEX） on efficacy,inflammatory factors,liver and kidney functions in severe sepsis patients with acute lung and kidney injury. Methods A total of 60 severe sepsis patients with acute lung and kidney injury were randomly divided into treatment group and control group,30 cases in each group. Patients in two groups were maintained with regular treatment. Patients in treatment group were received DEX injection1 μg·kg^（-1）·h^-1for early sedative treatment. While,patients in control group were received propofol injection for early sedative treatment. They were treated for 48 h. Time of mechanical ventilation,intensive care unit（ ICU） stay time,and duration of continuous renal replacement therapy（ CRRT） were recorded. Liver and kidney functions indexes and the levels of inflammatory factors in two groups before and after treatment were detected.Results ICU stay time and duration of CRRT in control group were（ 96. 32 ± 13. 51）,（ 61. 30 ± 9. 85） h,had significant difference with those in treatment group,which were（ 76. 18 ± 11. 32）,（ 52. 93 ± 9. 21） h（ P〈0. 01）.After operation,the levels of procalcitonin,C reactive protein,interleukin-6 and tumor necrosis factor in treatment group were（ 2. 05 ± 0. 39）,（ 56. 36 ± 9. 94）,（ 78. 72 ± 11. 33）,（ 17. 56 ± 4. 07） ng·L^-1,had significant differences with those in control group,which were（ 2. 43 ± 0. 24）,（ 79. 91 ± 12. 55）,（ 92. 07 ± 12. 55）,（ 24. 41 ± 4. 25）ng·L^-1（ all P〈0. 01）. After operation,the levels of alanine aminotransferase,aspartate transaminase,alkaline phosphatase,total bilirubin,blood urea nitrogen and serum creatinine in treatment group were（ 21. 37 ± 4. 73）U·L^-1,（ 29. 61 ± 6. 97） g · L^-1,（ 67. 27 ± 7. 26） U · L^-1,（ 11. 36 ± 2. 91） μmol · L^-1,（ 7. 03 ± 2. 03）mmol·L^-1,（ 87. 98 ± 10. 56） μmol · L^-1,had significant difference with those in control group,which were（ 30. 46 ± 6. 44） U· L^-1,（ 38. 60 ± 7. 53） g · L^-1,（ 71. 75 ± 8. 41） U · L^-1,（ 14. 72 ± 2. 29） μmol · L^-1,（ 10. 07 ± 3. 12） mmol·L^-1,（ 123. 73 ± 11. 74） μmol·L^-1（ all P〈0. 05）. There was no significant adverse drug reaction in two groups. Conclusion Compared with propofol,dexmedetomidine has better clinical effect for severe sepsis patients with acute lung injury by improving the inflammatory factors and protecting organ.