右美托咪定对慢性阻塞性肺疾病急性加重期机械通气患者的镇静作用

Sedative Effect of Dexmedetomidine on Patients with Mechanical Ventilation during Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的评价右美托咪定在慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者镇静治疗中应用效果。方法选择2017年1月-2018年12月在该院ICU治疗的62例AECOPD机械通气患者,随机分为对照组和观察组,各31例。两组均行有创机械通气。对照组予咪达唑仑镇静治疗,观察组予右美托咪定镇静治疗。比较两组临床应用效果。结果观察组RASS评分达到-2^+1分的时间为(48.90±5.13)min,与对照组(50.09±5.65)min比较差异无统计学意义(t=1.301,P=0.203);观察组唤醒、机械通气、ICU住院时间为(1.25±0.44)min、(5.12±1.23)d、(7.22±1.23)d,明显短于对照组(1.62±0.56)min、(5.87±1.28)d、(7.54±1.36)d(t=2.665、2.286、2.559,P=0.012、0.029、0.016);观察组谵妄发生率为12.90%,明显低于对照组(35.48%)(t=4.309,P=0.038);心血管不良反应发生率为51.61%,对照组为29.03%,两组比较差异无统计学意义(t=3.284,P=0.070)。结论右美托咪定与咪达唑仑对ICU AECOPD机械通气患者镇静效果相似,但右美托咪定对呼吸无明显影响且易唤醒,在减少谵妄发生,缩短机械通气和ICU住院时间方面更具优势。

Objective To evaluate the effect of dexmedetomidine in the sedation of patients with chronic obstructive pulmonary disease with acute exacerbation(AECOPD)mechanical ventilation.Methods From January 2017 to December 2018,62 patients with AECOPD mechanical ventilation who were treated in the hospital’s ICU were selected and randomly divided into a control group and an observation group,each with 31 patients.Both groups underwent invasive mechanical ventilation.The control group was sedated with midazolam,and the observation group was sedated with dexmedetomidine.The clinical application effects of the two groups were compared.Results The time for the RASS score of the observation group to reach-2^+1 was(48.90±5.13)min,which was not significantly different from that of the control group(50.09±5.65)min(t=1.301,P=0.203).The duration of ventilation and ICU stay was(1.25±0.44)min,(5.12±1.23)d,(7.22±1.23)d,significantly shorter than the control group(1.62±0.56)min,(5.87±1.28)d,(7.54±1.36)d(t=2.665,2.286,2.559,P=0.012,0.029,0.016);the incidence of delirium in the observation group was 12.90%,which was significantly lower than the control group(35.48%)(t=4.309,P=0.038);the incidence of vascular adverse reactions was 51.61%,and the control group was 29.03%.There was no statistical difference between the two groups(t=3.284,P=0.070).Conclusion Dexmedetomidine has a similar sedative effect to midazolam in patients with AECOPD mechanical ventilation in ICU,but dexmedetomidine has no significant effect on respiration and is easy to wake up,which is more advantageous in reducing delirium,mechanical ventilation and length of stay in ICU.