右美托咪定联合瑞芬太尼在慢性阻塞性肺疾病机械通气患者中的应用效果

Application effects of Dexmedetomidine combined with Remifentanil on chronic obstructive pulmonary disease patients with mechanical ventilation

目的:观察右美托咪定联合瑞芬太尼在慢性阻塞性肺疾病(COPD)机械通气患者中的应用效果。方法:选取60例行机械通气治疗的COPD患者为研究对象,按照随机数字表法分为观察组和对照组各30例。两组均给予咪达唑仑镇静后,对照组给予瑞芬太尼静脉泵注,观察组给予右美托咪定静脉泵注联合瑞芬太尼静脉推注,比较两组插管前、插管即刻、插管后10 min、拔管即刻和拔管后10 min时的心率(HR)、呼吸频率(RR)和平均动脉压(MAP)水平,插管后24、48 h时Ramsay镇静评分和视觉模拟评分法(VAS)评分,ICU住院时间和气管插管时间,以及不良反应发生率。结果:观察组插管即刻、插管后10 min、拔管即刻和拔管后10 min时HR、RR和MAP水平均低于对照组,差异有统计学意义(P<0.05);观察组插管后24、48 h时Ramsay镇静评分高于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05);观察组ICU住院时间和气管插管时间均短于对照组,差异有统计学意义(P<0.05);两组均未出现明显不良反应。结论:右美托咪定静脉泵注联合瑞芬太尼静脉推注应用于COPD机械通气患者,可稳定患者HR、RR、MAP水平,提高Ramsay镇静评分,降低VAS评分,缩短气管插管时间和ICU住院时间,效果优于单纯瑞芬太尼静脉泵注。

Objective:To observe application effects of Dexmedetomidine combined with Remifentanil on chronic obstructive pulmonary disease(COPD)patients with mechanical ventilation.Methods:60 COPD patients with mechanical ventilation were selected as the research objects,and were divided into observation group and control group according to the random number table method,30 cases in each.Both groups were given Midazolam sedation.After that,the control group was given intravenous infusion of Remifentanil,while the observation group was given intravenous bolus of Dexmedetomidine combined with Remifentanil.The heart rate(HR),respiratory rate(RR)and mean arterial pressure(MAP)levels before intubation,immediately after intubation,10 minutes after intubation,immediately after extubation and 10 minutes after extubation,the Ramsay sedation score and the visual analog scale(VAS)score 24 and 48 hours after intubation,the ICU stay time,the tracheal intubation time,and the incidence of adverse reactions were compared between the two groups.Results:The HR,RR and MAP levels of the observation group were lower than those of the control group immediately after intubation,10 minutes after intubation,immediately after extubation and 10 minutes after extubation,and the differences were statistically significant(P<0.05).The Ramsay sedation score in the observation group was higher than that in the control group 24 and 48 hours after intubation;the VAS score was lower than that in the control group;and the differences were statistically significant(P<0.05).The ICU stay time and the tracheal intubation time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).However,there were no obvious adverse reactions in both groups.Conclusions:Intravenous bolus of Dexmedetomidine combined with Remifentanil for the COPD patients with mechanical ventilation can stabilize the HR,RR,MAP levels,improve the Ramsay sedation score,reduce the VAS score,and shorten the tracheal intubation time and the ICU stay time.Moreover,it is superior to single intravenous infusion of Remifentanil.