不同镇痛镇静措施对慢性阻塞性肺疾病急性加重期机械通气患者的疗效分析

Efficacy analysis of different analgesia and sedation measures in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing mechanical ventilation

目的探讨右美托咪定与咪达唑仑分别联合舒芬太尼对慢性阻塞性肺疾病急性加重期(AECOPD)需机械通气患者的镇痛镇静效果。方法选取2016年1月至2017年12月接受机械通气治疗的AECOPD患者95例作为研究对象,咪达唑仑+舒芬太尼组(MS组)49例,右美托咪定+舒芬太尼组(DS组)46例,比较2组患者插管前及插管后1h呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、氧合指数(OI)的变化,记录插管时心血管不良事件、支气管痉挛等情况发生率,一次性插管成功率,用药过程中监测呼吸抑制发生率,停药后谵妄的发生率,对比分析2组患者的临床疗效。结果 2组患者插管前RR、HR、MAP及OI的比较均在失代偿期,差异无统计学意义(P>0.05),插管后1hR、HR、MAP均有降低,DS组降低较少,差异有统计学意义(P<0.05),OI均升高,组间比较差异无统计学意义(P>0.05),DS组患者镇静起始有效时间快,苏醒时间短,成功脱机拔管率高,呼吸抑制率、心血管不良事件及用药后谵妄发生率较低,差异有统计学意义(P<0.05),DS组一次性插管成功率稍低,组间比较差异无统计学意义(P>0.05),达到相同镇痛镇静目标,均等时间与同等体质量状态下,DS组医疗费用略高于MS组,差异无统计学意义(P>0.05)。结论对AECOPD机械通气患者实施2种镇痛镇静方案均能达到理想目标,DS组具有呼吸循环影响小,谵妄发生率低等优势,MS组具有插管成功率及呼吸抑制率高等优点,可根据病情选用合适的方案。

Objective To investigate the analgesic and sedative effects of dexmedetomidine and midazolam combined with sufentanil respectively in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）requiring mechanical ventilation.Methods Ninety-five AECOPD patients who underwent mechanical ventilation from Jan 2016 to Dec 2017 were selected as the research subjects,49 cases in midazolam ＋ sufentanil group（MS）and 46 cases in dexmedetomidine＋sufentanil group（DS）,the changes of respiratory rate（RR）,heart rate（HR）,mean arterial pressure（MAP）and oxygenation index（OI）before intubation and 1 hour after intubation were compared between the two groups,the incidence of cardiovascular adverse events and bronchospasm during intubation,the success rate of one-time intubation,the incidence of respiratory depression during medication,and the incidence of delirium after drug withdrawal were recorded,and the clinical effects of the two groups were compared and analyzed.Results Before the intubation,the comparison of RR,HR,MAP and OI were all during the decompensation period,the difference was not statistically significant（P〈0.05）.One hours after intubation,RR,HR and MAP all decreased,DS group decreased less,the difference was statistically significant（P〈0.05）,but OI all increased,and there was no significant difference（P〈0.05）,the patients in DS group had fast effective sedation time,short recovery time,high successful extubation rate offline,low respiratory depression rate and delirium rate,less adverse cardiovascular events after medication,the difference was statistically significant（P〈0.05）,the success rate of one-time intubation was slightly lower,and there was no significant difference（P〈0.05）.In order to achieve the same goal of analgesia and sedation,the medical expenses in DS group were slightly higher than those in MS group under the condition of equal time and weight,and the difference was not statistically significant（P〈0.05）.Conclusion Both analgesia and sedation schemes for AECOPD patients with mechanical ventilation can achieve the ideal goal,DS group has the advantages of little influence on respiratory cycle and low delirium rate,MS group has the advantages of successful intubation rate and high respiratory inhibition rate,the suitable plan can be selected according to the condition of the disease.