右美托咪定联合丙泊酚对ARDS机械通气患者应激水平及炎性因子的影响

Effects of dexmedetomidine combined with propofol on stress status and inflammatory factors in ARDS patients undergoing mechanical ventilation

目的研究右美托咪定联合丙泊酚对ARDS机械通气患者应激水平及炎性因子的影响和镇静效果。方法选择2016年4月至2017年4月在我院ICU进行机械通气,时间>24 h的90例危重症患者,随机分为右美托咪定联合丙泊酚组(联合组)、右美托咪定组和丙泊酚组,每组30例,分别采用相应药物进行镇静。观察机械通气1、3、7 d时三组患者儿茶酚胺(肾上腺素、去甲肾上腺素)、炎性因子(TNF-α、IL-6)的水平,记录治疗期间各组低血压、心动过缓等不良反应发生率。结果三组患者治疗前后0.5 h的平均动脉压(MAP)、心率(HR)比较,差异有统计学意义(P<0.05)。联合组治疗后MAP为(70.7±9.4)mmHg,HR为(60.5±6.9)次/min,明显优于右美托咪定组和丙泊酚组,差异有统计学意义(P<0.05)。治疗后1、3、7 d,联合组AD、NE、IL-6、IL-10明显优于右美托咪定组和丙泊酚组,差异有统计学意义(P<0.05)。结论右美托咪定联合丙泊酚对ARDS机械通气患者的镇静效果较单独使用右美托咪定和丙泊酚显著,对抑炎因子IL-10的分泌有一定抑制作用,对疾病的治疗有积极作用,值得在临床上应用。

Objective To study the effect of status and inflammatory factors and the sedative effect in ARDS patients 90 critically ill patients with mechanical ventilation time more than 24 h combined with propofol on the levels of stress with mechanical ventilation. Methods Totally in ICU of our hospital from April 2016 to April 2017 were selected and randomly divided into 3 groups ,30 cases in each group. Dexmedetomidine and propofol group （combination group）, dexmedetomidine group and propofol group, which were treated with corresponding drugs for sedation. The levels of catecholamine （epinephrine and norepinephrine） and inflammatory factors （TNF-α and IL-6 ） of the three groups were observed at 1,3 and 7 d after mechanical ventilation, and the incidence of hypotension, bradycardia and other adverse events were recorded during the treatment. Results There were significant differences in MAP and HR at 0. 5 h before and after treatment among the three groups （ P 〈 0. 05 ）. The MAP of combination group was （70. 7 ± 9.4） mmHg, and HR was （ 60. 5±6. 9 ） bpm, which were superior to those of dexmedetomidine group and propofol group （P 〈 0. 05 ）. At 1,3 and 7 d after treatment, the AD, NE, IL-6 and IL-10 in combination group were sig- nificantly better than those in dexmedetomidine group and propofol group （P 〈 0. 05 ）. Conclusion The sedative effect of dexmedetomidine combined with propofol on patients with ARDS mechanical ventilation is significantly better than that of dexmedetomidine and propofol alone. It has certain inhibitory effect on the secretion of IL-10, and positive clini- cal efficacy, which is worthy of clinical application.