咪达唑仑与右美托咪定对ICU慢性阻塞性肺疾病急性加重期机械通气患者的临床应用分析

Analysis of Midazolam and Dexmedetomidine in Application of Patients with Chronic Obstructive Pulmonary Disease Requiring Mechanical Ventilation during Acute Exacerbation Period

目的探讨咪达唑仑与右美托咪定对重症监护病房ICU慢性阻塞性肺疾病急性加重期需机械通气患者的临床应用价值。方法选取我院(ICU)2015年3月—2018年6月收治的行机械通气治疗的COPD急性加重期患者96例为研究对象,按镇静药物的不同分为A组46例、B组50例。A组给予咪达唑仑镇静,B组给予右美托咪定镇静,比较2组镇静效果、镇静不良反应及终点事件发生情况。结果 A组镇痛药物的使用率、镇静起效时间、停药后唤醒时间均高于B组(P<0.05);A组谵妄发生率、谵妄持续时间、呼吸抑制发生率均高于B组,低血压发生率低于B组(P<0.05),2组低血压药物干预率比较差异无统计学意义(P>0.05)。2组心动过缓发生率及药物干预率比较均无差异(P>0.05);A组入住ICU时间、机械通气时间、首次脱机呼吸抑制率均多于B组,成功脱机拔管率低于B组(P<0.05),2组28 d病死率比较差异无统计学意义(P>0.05)。结论右美托咪定相较于咪达唑仑对ICU慢性阻塞性肺疾病急性加重期需行机械通气患者有更好的镇静效果,且可降低镇静不良反应,缩短ICU住院时间。

Objective To investigate clinical value of Midazolam and Dexmedetomidine in application of patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation during acute exacerbation period in intensive care unit (ICU). Methods A total of 96 COPD patients with mechanical ventilation therapy during acute exacerbation period in ICU admitted during March 2015 and June 2018 were divided into group A ( n =46) and group B ( n =50) according to different administration of sedative drugs. Group A was treated with Midazolam sedation, while group B was treated with Dexmedetomidine sedation. Sedative effect, adverse reactions of sedation and incidence rate of end-point events were compared between two groups. Results In group A, values of use rate of sedation drugs, onset time of sedation and wake-up time after drug withdrawal were significantly lower than those in group B ( P <0.05);values of incidence rate of delirium, delirium duration and incidence rate of respiratory depression were significantly higher ( P <0.05), while incidence rate of hypotension was significantly lower than those in group B ( P <0.05). There was no significant difference in intervention rate of hypotension drug between two groups ( P >0.05). There were no significant differences in incidence rate of bradycardia and intervention rate of drug between two groups ( P >0.05). In group A, values of duration of ICU admission, time of mechanical ventilation and respiratory depression rate of the first off-line were significantly higher, while extubation rate of successful off-line was significantly lower than those in group B ( P <0.05). There was no significant difference in 28 d mortality rate between two groups ( P >0.05). Conclusion Compared with those by Midazolam, Dexmedetomidine has a better sedative effect in application of COPD patients with requiring mechanical ventilation during acute exacerbation period in ICU, and it can reduce adverse reactions of sedation and shorten duration of ICU hospital stay.