早期目标导向镇静用于慢性阻塞性肺疾病急性加重机械通气患者的临床观察

Clinical effects of early goal-directed sedation on AECOPD patients with invasive mechanical ventilation

目的探讨以右美托咪定为基础的早期目标导向镇静(EGDS)用于慢性阻塞性肺疾病急性加重(AECOPD)有创机械通气患者的临床价值,以及相对于传统标准镇静方案(STDS)的优势。方法选取52例慢性阻塞性肺疾病(COPD)急性加重患者,有创机械通气大于12 h,随机分为EGDS组和STDS组,比较两组患者的浅镇静达标率、机械通气时间、住院时间、不良反应的发生率以及镇静药物调整次数等。结果两组患者机械通气48 h内,EGDS组浅镇静达标率明显高于STDS组(58.8%比37.8%,P=0.01)。EGDS组患者7天内拔除气管插管率高于STDS组(85%比70%,P=0.01),ICU住院时间更短(5.5(4.2~9.7)比6.5(3.2~10.2),P=0.04),镇静剂的调整次数低于STDS组,不良反应(包括谵妄、血管活性药物的使用)更少。结论早期目标导向镇静(EGDS)用于慢阻肺急性加重机械通气患者是可行的、安全的。以右美托咪定为基础的EGDS较传统镇静药物更具优势,不良反应少,更具实用价值。

Objective To investigate the clinical value and advantage of delivering early goal-directed sedation on AECOPD patients with invasive mechanical ventilation compared with standard sedation.Methods 52 patients with AECOPD who accepted invasive mechanical ventilation in ICU were randomly divided into the EGDS group(n=26)and the STDS group(n=26).The percentage of RASS scores(the early 48 hours)in light sedation range,the duration of mechanical ventilation and ICU stay,the incidence of adverse complications and the numbers of adjusted sedative dose were recorded.Results The percentage of RASS scores in light sedation range in the EGDS group was higher than that in the STDS group(5%vs70%,P=0.01).The duration of ICU stay in the EGDS group was shorter than that in the STDS group(5.5(4.2~9.7)vs 6.5(3.2~10.2),P=0.04).The number of adjusted sedative dose and the incidence of adverse complications(including delirium and using vascular active drugs)were lower in the EGDS group than in the STDS group.Conclusion Delivery of early goal-directed sedation is feasible and safe.EGDS based on dexmedetomidine is superior and more practical than STDS.