丙泊酚和右美托咪定长时间镇静对危重症机械通气患者的临床效果及发生胃肠损伤的相关研究

Effect of prolonged sedation with propofol and dexmedetomidine on acute gastrointestinal dysfunction injury and prognosis in ICU patients

目的探讨丙泊酚和右美托咪定长时间镇静对重症监护室(ICU)患者发生急性胃肠损伤(AGI)的影响.方法采用前瞻性队列研究方法,收集合肥市第二人民医院ICU 2017年8月至2018年12月收治的危重症机械通气患者200例,按照简单随机分组原则分为两组,每组100例.对照组给予丙泊酚镇静,观察组给予丙泊酚联合右美托咪定镇静,两组患者均给予舒芬太尼镇痛.记录患者的基本临床资料,包括年龄、性别、体质量、体质量指数(BMI)、血清白蛋白水平、急性生理及慢性健康评分Ⅱ(APACHEⅡ)评分、甘油三酯(TG)、总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST).比较两组患者使用镇静剂后第0、7天肠鸣音评分及发生AGI例数、发生谵妄例数、TG、TC、ALT、AST及两组患者入住ICU的时间和费用.结果与入科时(0 d)比较,两组TG、TC、ALT、AST均升高,但观察组上升幅度均低于对照组,差异均有统计学意义(t=3.87、4.58、5.26、4.38,P=0.00、0.00、0.00、0.00).对照组共发生AGI 85例,观察组共发生AGI 70例,差异有统计学意义(x2=8.62,P=0.03);两组患者肠鸣音评分差异有统计学意义(x2=11.48,P=0.00);对照组共13例出现谵妄,观察组共2例出现谵妄,差异有统计学意义(x2=11.83,P=0.00);两组患者入住ICU时间和费用差异均无统计学意义(均P>0.05).结论对于ICU需长时间机械通气患者,右美托咪定可明显降低谵妄发生率及AGI发生,且对患者肝功能及血脂代谢影响小,可显著改善预后.

Objective To investigate the effect of prolonged sedation with propofol and dexmedetomidine on acute gastrointestinal dysfunction injury(AGI)and prognosis in intensive care unit(ICU)patients.Methods A prospective cohort study was conducted to collect 200 cases of mechanical ventilation patients admitted to ICU in the Second Peoples Hospital of Hefei,and the patients were divided into two groups according to the simple random grouping principle,with 100 cases in each group.The control group was given propofol sedation,and the research group was given propofol combined with dexmedetomidine sedation.Both two groups were given sufentanil for analgesia,and the basic clinical data of the patients were recorded,including age,gender,weight,BMI index,serum albumin levels,acute physiology and chronic health evaluation U(APACHE U)score,triglycerides(TG),total cholesterol(TC),alanine aminotransferase(ALT),aspartate ami notransferase(AST).On the Oth and 7 th day after the use of sedatives,the intestinal singing score,cases of acute gastrointestinal dysfunction injury,cases of delirium,length of stay in the ICU and hospitalization costs,TG,TC,ALT and AST in the two groups were observed and compared.Results The TG,TC,ALT and AST levels were all increased in the two groups compared with those at the Od,but the increase degree in the study group was lower than that in the control group,and the differences were statistically significant(t=3.87,4.58,5.26,4.38,P=0.00,0.00,0.00,0.00).A total of 85 patients in the control group developed AGI,and 70 patients in the study group developed AGI.The difference between the two groups was statistically significant(X2=8.62,P=0.03),and the difference in intestinal sound score between the two groups was statistically significant(X2=11.48,P=0.00).There were 13 delirium cases in the control group and 2 delirium cases in the study group,and the difference was statistically significant(t=11.83,P=0.00).There were no statistically significant differences in the length of hospital stay(t=1.64,P=0.10)and hospital expenses(t=1.28,P=0.20)between the two groups.Conclusion For ICU patients requiring long-term mechanical ventilation,dexmedetomidine can significantly reduce the incidence of delirium and the occurrence of AGI,especially for obese patients,the use of dexmedetomidine sedation has little impact on their liver function and blood lipid metabolism,and can significantly improve the prognosis.