右美托咪定在无创机械通气治疗中重度哮喘急性期的疗效评价

Efficacy of Dexmedetomidine in the Treatment of Acute Moderate to Severe Asthma with Noninvasive Mechanical Ventilation

目的探讨右美托咪定在中、重度哮喘急性期患者给予无创机械通气治疗中的疗效评价。方法选取本院重症医学科收治中、重度哮喘急性期合并低氧血症,给予无创机械通气患者65例,随机分为对照组(n=30例),观察组(右美托咪定治疗组,n=35例)。对照组患者给予常规哮喘治疗联合无创机械通气,观察组患者同时给予右美托咪定以0.2~0.4μg/(kg·h)持续静脉泵入,观察两组患者无创机械通气时间、转为有创机械通气发生率、ICU住院时间、总住院时间;两组患者入重症医学科时、出院前1d测定肺功能,记录两组患者28d病死率,不良事件发生率,对结果进行统计学分析。结果与对照组相比,观察组患者无创机械通气时间更短(t=-2.301、P=0.025);住ICU时间更短(t=-2.769、P=0.007);总住院时间更短(t=-2.329、P=0.023)。两组患者肺功能情况第一秒用力呼气容积(Forced expiratory volume in one second,FEV_1)、呼气峰流速值(Peak expiratory flow,PEF)出院时较入院时均有好转,与对照组相比,观察组改善明显(P<0.05);FEV_1(实测值/预测值)百分比两组出院时较入院时均有好转,但两组差异无统计学意义(P>0.05)。其中治疗过程中行气管插管有创机械通气观察组7例(20%),对照组6例(20%);28d病死率观察组3例(8%),对照组2例(6%);差异无统计学意义(P>0.05)。其中不良观察组35例中,2例发生心率过缓(<50次/min),并终止使用右美托咪定。结论右美托咪定在中、重度哮喘急性期无创机械通气患者中有助于改减少无创机械通气时间、缩短住ICU时间及住院时间,并可能能改善患者哮喘严重程度,但并不能减少有创机械通气插管率、不能降低28d病死率,同时需警惕药物不良反应发生。

Objective To investigate the efficacy of dexmedetomidine in the treatment of acute moderate to severe asthma patients with noninvasive mechanical ventilation. Methods 65 cases of acute moderate to severe asthma patients complicated with hypoxemia and treated with noninvasive mechanical ventilation in department of critical care medicinewere in our hospital were se- lected and randomly divided into control group（ n = 30 cases）and observation group（ dexmedetomidine treatment group, n = 35 ca- ses）. The control group was given conventional asthma treatment combined with noninvasive mechanical ventilation, while the ob- servation group was given dexmedetomidine continuous intravenous infusion of 0. 2-0. 4ug/kg/h at the same time. The duration of non-invasive mechanical ventilation, the incidence of conversion to invasive mechanical ventilation, the length of ICU stay and total hospitalization time were compared between the two groups. In the two groups of patients into critical care medicine, and the day be- fore discharge, the lung function of the two groups were tested, and the 28 day mortality rate and adverse event rate of the two groups of patients were recorded, and the results were statistically analyzed. Results Compared with the control group, the patients in the observation group had shorter time of non-invasive mechanical ventilation （ t = -2. 301, P = 0. 025 ）, shorter ICU stay （ t = - 2. 769, P = 0. 007 ）, and shorter total hospitalization time （t =2. 329, P = 0. 023 ）. The lung function like forced expiratory volumein one second （FEV1 ）, Peak expiratory flow（PEF） of the two groups was better than that of the hospital at the time of discharge. Compared with the control group, the observation group improved significantly（ P 〈 0.05 ） ;FEV1 （ measured value / predictive val- ue） percentage of the two groups were better than those of the hospital at the time of discharge, but there was no significant differ- ence between the two groups. Among them,7 patients（ 20% ）received endotracheal intubation and invasive mechanical ventilation in the observation group, and 6 patients in the control group（20% ） ;The 28 day mortality rate was 3 in the observation group（ 8% ） and 2 in the control group （6%）. There was no significant difference between the two groups （P 〉 0.05 ）. The adverse observation group of 35 patients, and 2 patients had bradycardia（ 〈 50 / min）, which were terminated the use of dexmedetomidine. Conclusion In acute moderate to severe asthma patients with non-invasive mechanical ventilation, the use of dexmedetomidine can help re- duce noninvasive mechanical ventilation time, ICU stay time and hospitalization time, and can improve the patients with asthma se- verity, but it can not reduce the mechanical ventilation rate of intubation, and can not reduce the mortality rate of 28 days, at the same time we need to alert the appearance of adverse drug reactions.