右美托咪啶在ICU重症住院患者中的应用效果及对谵妄发生率的影响

Application of dexmedetomidine in critically ill ICU patients and its impact on the incidence of delirium

目的探讨右美托咪啶在ICU重症住院患者中的应用效果及对谵妄发生率的影响。方法选取本院2015年7月至2017年12月期间收治的ICU住院患者104例为研究对象。采用随机数字表法将其分为对照组和观察组,各52例。观察组泵入盐酸右美托咪啶注射液进行镇静,对照组泵入咪达唑仑注射液进行镇静,比较两组镇静前后血流指标(HR、SBP、DBP、SpO2)变化、谵妄发生时间及发生率。结果两组患者镇静前HR、SBP、DBP及SpO2等指标比较差异无统计学意义;对照组镇静后SBP、DBP下降(P<0.05),HR及SpO2无变化;观察组镇静后HR下降(P<0.05),SBP、DBP、SpO2无变化;观察组镇静后HR低于对照组,SBP、DBP高于对照组(P<0.05);观察组谵妄发生时间为镇静后(5.88±1.21)h明显迟于对照组(4.35±1.06)h,谵妄发生率(7.69%)明显低于对照组(25.00%),差异有统计学意义(P<0.05)。结论应用右美托咪定镇静时可降低ICU住院患者的心率,但对患者血压及血氧饱和度无明显影响,同时,右美托咪定可推迟患者谵妄发生时间,降低谵妄的发生率,临床应用效果满意。

Objective To investigate the effect of dexmedetomidine on the incidence of delirium in ICU patients. Methods 104 cases of ICU admitted to our hospital from July 2015 to December 2017 were selected as the research subjects. They were divided into control group and observation group by random number table grouping method, 52 cases in each group. The observation group was sedated by dexmedetomidine hydrochloride injection, and the control group was sedated by midazolam injection. The changes of blood flow indexes (HR, SBP, DBP, SpO2) before and after sedation, the occurrence time and incidence of delirium were compared between the two groups. Results There was no significant difference in HR, SBP, DBP and SpO2 between the two groups before sedation;SBP, DBP decreased after sedation in the control group (P<0.05), HR and SpO2 did not change;HR decreased after sedation in the observation group (P<0.05), SBP, DBP, SpO2 did not change;HR in the observation group after sedation was lower than that in the control group. SBP and DBP in the observation group were higher than those in the control group (P<0.05), delirium occurrence time in the observation group was (5.88±1.21) h after sedation was significantly later than that in the control group (4.35±1.06) h, and the incidence of delirium (7.69%) was significantly lower than that in the control group (25.00%)(P<0.05). Conclusion Dexmedetomidine sedation can reduce the heart rate of ICU inpatients, but has no significant effect on blood pressure and oxygen saturation. At the same time, dexmedetomidine can postpone the onset of delirium and reduce the incidence of delirium. The clinical effect is satisfactory.