舒芬太尼联合右美托咪定对机械通气患者睡眠及谵妄的影响

Effect of Sufentanil Combined with Dexmedetomidine on Sleep and Delirium in Patients with Mechanical Ventilation

目的探讨机械通气患者采取舒芬太尼联合右美托咪定的应用效果及其对患者睡眠状况及谵妄发生率的影响。方法随机将作者医院2017-01/2018-12月接收的重症监护病房(intensive care unit,ICU)机械通气患者200例分为两组,对照组(n=100)采取舒芬太尼联合咪达唑仑,研究组(n=100)采取舒芬太尼联合右美托咪定。对比两组用药前后血流动力学、谵妄及不良反应发生率、睡眠质量评分、ICU留住时间、机械通气时间及气管插管时间。结果在心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)及脉搏血氧饱和度(pulse oxygen saturation,SpO2)方面,两组用药前对比,差异无统计学意义(P>0.05);用药后6 h、12 h、24 h、48 h,研究组HR、MAP、SpO2显著优于对照组,差异有统计学意义(P<0.05);在ICU留住时间、机械通气时间、气管插管时间及失眠评分方面,研究组均明显低于对照组,差异有统计学意义(P<0.05);在谵妄及不良反应发生率方面,研究组均显著低于对照组,差异有统计学意义(P<0.05)。结论 ICU机械通气期间,应用舒芬太尼联合右美托咪定,不仅可以平稳患者血流动力学水平,缩短患者ICU留住时间及机械通气时间,同时有助于改善患者睡眠质量,降低谵妄及不良反应发生率。

Objective To explore the effect of sufentanil combined with dexmedetomidine in patients with mechanical ventilation and its effect on the sleep status and delirium incidence.Methods A total of 200 patients with intensive care unit(ICU)mechanical ventilation received in authors′hospital from January 2017 to December 2018 were enrolled in this study.The control group(n=100)was treated with sufentanil combined with midazolam,the study group(n=100)was treated with sufentanil combined with dexmedetomidine.Hemodynamics,incidence of delirium and adverse reactions,sleep quality score,ICU retention time,mechanical ventilation time,and tracheal intubation time were compared between the two groups before and after treatment.Results In terms of heart rate(HR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO2),there was no significant difference between the two groups before treatment(P>0.05).At 6,12,24 and 48 hours after treatment,the levels of HR,MAP and SpO2 of the study group were significantly better than those of control group(P<0.05).Retention time in ICU,mechanical ventilation time,endotracheal intubation time and insomnia score of study group were significantly lower than those of control group(P<0.05).In the incidence of delirium and adverse reactions,the study group was significantly lower than the control group(P<0.05).Conclusion During ICU mechanical ventilation,the application of sufentanil combined with dexmedetomidine can not only stabilize the patient′s hemodynamics level,shorten ICU retention time and mechanical ventilation time,but also help improve the patient′s sleep quality,reduce the incidence of delirium and adverse reactions.