右美托咪定用于机械通气重症患者镇静的效果及经济评价

Effect and Economic Evaluation of Dexmedetomidine for Sedation in Critically Ill Patients with Mechanical Ventilation

目的比较机械通气患者使用右美托咪定和咪达唑仑镇静的临床效果及治疗费用。方法选择2017年1月~2019年1月绵阳市中心医院ICU收治的需要机械通气的患者48例,采用随机数字表法分为右美托咪定组和咪达唑仑组,各24例。观察并记录两组患者镇静药物的用量、机械通气时间、入住ICU时间、镇静药物费用、机械通气费用和ICU总医疗费用。结果右美托咪定组镇静药物用量为(0.63±0.15)μg/(kg·h)、镇静药使用总量为(2.72±1.01)mg,分别少于咪达唑仑组的(56.89±14.28)μg/(kg·h)、(301.86±113.25)μg/(kg·h);右美托咪定组机械通气时间为(4.12±1.92)d、入住ICU时间为(6.43±2.81)d,分别短于咪达唑仑组的(5.92±2.64)d、(8.13±3.26)d,差异均有统计学意义(P<0.05);右美托咪定组镇静药物费用为(2562.08±889.74)元,高于咪达唑仑组的(784.6±229.48)元,机械通气费用为(4030.12±1364.25)元,低于咪达唑仑组的(5835.38±1842.76)元,住ICU总医疗费用为(22160.92±7864.53)元,低于咪达唑仑组的(29619.62±9835.78),差异均有统计学意义(P<0.05)。结论使用右美托咪定镇静不仅具有缩短患者机械通气时间和入住ICU时间的临床效应,同时能降低ICU总医疗费用,兼具临床和药物经济学优势,与咪达唑仑比较,是较为经济合理的镇静药物。

Objective To compare the clinical effects and treatment costs of dexmedetomidine and midazolam sedation in mechanically ventilated patients. Methods 48 patients requiring mechanical ventilation from January 2017 to January 2019 in the ICU of Mianyang Central Hospital were randomly divided into the dexmedetomidine group and the midazolam group, 24 cases each. Observe and record the amount of sedative medication, mechanical ventilation time, ICU stay, sedative medication costs, mechanical ventilation costs, and ICU total medical costs. Results The dose of sedative drugs in the dexmedetomidine group was (0.63±0.15)μg/(kg·h), and the total amount of sedatives used was (2.72±1.01) mg, which was less than that of the midazolam group (56.89±14.28)μg/(kg·h),(301.86±113.25)μg/(kg·h);the mechanical ventilation time of dexmedetomidine group was (4.12±1.92) d, and the time of staying in ICU was (6.43±2.81)d. They were shorter than the midazolam group (5.92±2.64) d and (8.13±3.26) d, the difference was statistically significant (P<0.05);the dexmedetomidine group sedative drug cost was (2562.08±889.74) yuan, higher than the midazolam group (784.6±229.48) yuan, the mechanical ventilation cost was (4030.12±1364.25)yuan, lower than the midazolam group (5835.38±1842.76)yuan, the total medical cost of living in the ICU was ( 22160.92±7864.53)yuan, lower than the midazolam group (29619.62±9835.78), the difference was statistically significant (P<0.05). Conclusion The use of dexmedetomidine sedation not only has the clinical effect of shortening the time of mechanical ventilation and ICU stay, but also reduces the total medical cost of ICU. It has both clinical and pharmacoeconomic advantages. Compared with midazolam, it is more economical reasonable sedative drugs.