早期目标导向镇静下不同镇静药物对谵妄发生的影响

Influence of Different Sedatives on Delirium under Early Goal-Directed Sedation

目的研究在早期目标导向镇静策略下,右美托咪定、咪达唑仑、丙泊酚三种药物对谵妄发生的影响。方法选取川北医学院附属医院重症医学科需要接受镇静治疗的患者100例(2016年1月至2017年6月),随机分配接受右美托咪定(A组)、咪达唑仑(B组)、丙泊酚(C组)镇静治疗。躁动镇静评分量表评估各组镇静的水平,以达到躁动镇静评分-2^+1分镇静目标。用重症监护病房意识模糊评估法评估患者是否发生谵妄及持续时间。结果 A组能维持更长时间的浅镇静水平。A组谵妄的发生率,谵妄持续时间和身体约束比例优于其他两组,三组机械通气时间、住ICU时间、ICU病死率没有统计学差异。C组的血流动力学变化差异有统计学意义。结论在早期目标导向镇静策略下,右美托咪定能更好的预防谵妄发生,减少谵妄持续时间,维持血流动力学稳定,促进人文关怀。

Objective To research the influence of dexmedetomidine,midazolam,propofol three sedatives on delirium under early goal-directed sedation.Methods 100 cases of patients needing sedative treatment from January 2016 to June 2017 selected from Intensive Care Unit of affiliated hospital of north Sichuan medical college were randomly assigned to receive the dexmedetomidine(group A),midazolam(group B),propofol(group C)sedative therapy.Sedation-Agitation scale was used to evaluate sedation level of each group in order to achieve the goal of-2^+1 scores.The confusion assessment method for the Intensive Care Unit was used to assess whether delirium occured to patients and its duration.Results Group A could maintain shallow level of sedation for longer time.The incidence of delirium,delirium duration and physical restraint proportion of group A were superior to the other two groups.There was no statistically significant difference in mechanical ventilation time,ICU stay time and ICU fatality of three groups.Hemodynamic changes of group C was statistically significant.Conclusion Right under the early goal-directed sedation strategy,the dexmedetomidine can better prevent delirium occurring,reduce the duration of delirium,maintain hemodynamic stability and promote the humanistic care.