右美托咪定应用于机械通气脓毒症患者的疗效分析

Therapeutic effect of dexmedetomidine in sepsis patients with ITiecharnCal ventilation

目的观察右美托咪定(dexmedelomidine.DF.X)对机械通气脓毒症患者病情的影响方法选取2018年1 -12月徐州医科大学附属医院急诊ICL收治脓毒症并行机械通气的60例患者为研究对象.采用随机数字表法将患者分为DEX组和丙泊酚组各30例,分别采用右美托咪定和丙泊酚镇静,控制躁动-镇静评分系统(thecontrol of the sedation-sedation scoring system, RASS)评分在-2~0 分;2 组患者分别于用药前(TO),用药后 24 h(Tl)、48 h(T2)和72 h(T3)时抽取静脉血检测肝肾功能指标.同时行血气分析检测乳酸水平并计算氧和指数(PaO/FiOj;比较两组患者接受镇静治疗后第5天、第10天时SOFA和APACHE II评分.统计机械通气时间、ICU住院时间,28 d死亡率及不良反应发生率,结果两组间性别、年龄、SOFA评分,APACHE II评分等基线指标差异无统计学意义(P>0.05)。两组患者治疗后Lae、AI.T、TBIL、AST,Urea、SCr等指标较治疗前显著下降,PO2/FiO2逐步升高,差异有统计学意义(P<0.05);治疗后第5和第10天APACHE II及SOFA评分均明显改善,差异有统计学意义(P<0.05);DEX组患者上述指标的改善情况优于丙泊酚组,组间比较差异有统计学意义(P<0.05),两组患者机械通气时间、ICU入住时间、不良事件发生率及28 d病死率比较.差异无统计学意义(P> 0.05)。结论DEX能改善对机械通气脓毒症患者肺功能及肝肾功能,需要进行大样本RCT研究验证DEX是否能改善这类患者的预后。

Objective To observe the effect of dexmedetomidine (DEX) on the condition of patients with inechanical ventilation sepsis. Methods Sixty patients with sepsis and mechanical ventilation in the emergeney ICU of Xuzhou Medical University Hospital from Januaiy to December 2018 were enrolled. The patients were divided into DEX gnwp and propofol group with 30 cases each by random number table method. The two groups of patients were heated with dexmedetomidine and propofol sedation, and the control of the sedation-sedation scoring system (R ASS) score was -2 to 0 points. Venous blood was taken and tested before (TO). 24 hours (T1). 48 hours (T2), and 72 hours (T3) after treatment to detect liver and kidney function indexes, blood gas analysis was performed to detect lactic acid (Lac) level and oxygen and index (PaOJFiCh) were calculated. The score of Sequentiiil Organ Failure Assessment (SOFA) and Acute Physiology and (Jnonic Hetiltli Evaluation U (APACHE H ) were compared al the 5th and 10th day after sedation in the two groups.The time of mechanical ventilalion.lrnglli of stay in ICU. incidence of adverse events and 28-day mortality were counted. Results There were no significant differences in gender, age. SOFA score. APACHE II score between the two groups (P >0.05). The levels of L<ic, ALT. TB1L. AST. Urea. S( j- and other indicators in the two groups were significantly lower than brfoie treatment, the(lifferen( p was statistically significant (P <0.05). POVFiO: was gradually rising in the two groups. The scores of APA('HI'II and SOFA improved significantly on the 5th and lOtli day after sedation in the two groups, the difference was statistically significant (P <().()5). After treainenmt. the changes of the above indexes in dexmedetomidine group were more obvious than propofol group, the differenee between groups was statistically significant (P <0.05). The time of staying in ICU hospitalization (d: 13.00±5.80 vs 13.03±7.50), the time of niechanica) ventilation (d:9.90±5.86 vs 11.87±8.20), 28-d mortality (26.67% vs 33.337%)an(l adverse event rates (6.67% vs 16.67%) were no significant difference between the two groups (P >0.05). Conclusion DEX can improve lung function and liver and kidney function in patients with mechanical ventilation of sepsis. A large sample RCT study is needed to verify whether DEX can improve the prog nosis of these patients.