右美托咪定对肝损伤患者入ICU行机械通气的影响

Effect of dexmedetomidine on mechanical ventilation in patients with liver injury entering ICU

目的探讨右美托咪定对肝损伤患者入ICU行机械通气的影响。方法选取牡丹江医学院附属红旗医院重症医学科2019年3月至2020年2月间收治的90例肝损伤入ICU行机械通气患者为本次研究对象,按随机数字表法分为三组:A组[咪达唑仑0.1 mg/(kg·h)]、B组[右美托咪定0.5μg/(kg·h)]和C组[右美托咪定0.7μg/(kg·h)],每组各30例。患者入ICU后立即静脉泵注镇痛镇静药物,并均给予泵注盐酸瑞芬太尼5μg/(kg·h)镇痛及抗感染、保肝及升压等常规治疗。比较三组患者给药前(T0)、给药后2 h(T1)、8 h(T2)、24 h(T3)、48 h(T4)以及72 h(T5)组间的MAP、HR、RASS评分;比较三组患者T0、T3、T4和T5时刻的ALT、AST、TBIL、ALP、A/G、IL-6和TNF-α水平变化,并观察低血压和心动过缓等不良反应的发生情况。结果(1)A组MAP值优于C组(P<0.05);(2)三组患者均达到较好的镇静水平;(3)与A组相比,B、C两组除A/G明显升高外,其余各项肝功能指标、IL-6和TNF-α均明显降低,且C组较B组变化更为明显(P<0.05);(4)三组患者不良反应发生情况无统计学意义(P>0.05)。结论右美托咪定用于肝损伤患者入ICU行机械通气时,可满足较好的镇静水平,减少促炎细胞因子的释放,抑制炎症反应,对肝损伤患者有益,但对组织灌注不足患者存在不良影响。

Objective To investigate the effect of dexmedetomidine on mechanical ventilation in patients with liver injury entering the ICU.Methods Ninety patients with liver injury who were admitted to the ICU and undergoing mechanical ventilation in the Department of Critical Care Medicine, Hongqi Hospital, Mudanjiang Medical College, were selected as the subjects of this study.They were divided into three groups according to a random number table: A Group [Midazolam 0.1 mg/(kg·h)],group B [dexmedetomidine 0.5 μg/(kg·h)] and group C [dexmedetomidine 0.7 μg/(kg·h) ],30 cases in each group.After entering the ICU,the patients were given intravenous injection of analgesia and sedative drugs, and were given pump injections of remifentanil hydrochloride 5 μg/(kg·h) for analgesia, anti-infection, liver protection, and blood pressure.Compare the MAP,HR,HR,HR and HR of the three groups before administration(T0),2 h(T1),8 h(T2),24 h(T3),48 h(T4) and 72 h(T5) after administration.RASS score;compare the changes in the levels of ALT,AST,TBIL,ALP,A/G,IL-6 and TNF-α at T0,T3,T4 and T5 in the three groups of patients, and observe the adverse reactions such as hypotension and bradycardia Something happened.Results(1) The MAP value of group A was better than that of group C(P<0.05);(2) the three groups of patients reached a better level of sedation;(3) compared with group A,the two groups B and C except A/G Except for the obvious increase, the other liver function indexes, IL-6 and TNF-α were significantly reduced, and the changes in group C were more obvious than those in group B(P<0.05);(4) There was no adverse reaction in the three groups.Statistically significant(P>0.05).Conclusion When dexmedetomidine is used in ICU for mechanical ventilation in patients with liver injury, it can meet a better level of sedation, reduce the release of pro-inflammatory cytokines, and inhibit inflammation.It is beneficial to patients with liver injury, but is beneficial to patients with insufficient tissue perfusion, there are adverse effects.