机械通气脓毒症患者应用舒芬太尼联合咪达唑仑镇静前后免疫功能及细胞因子水平的变化

Changes of immune function and cytokine levels before and after sedation with sufentanil combined with midazolam in sepsis patients under mechanical ventilation

目的:通过对机械通气脓毒症患者采用舒芬太尼联合咪达唑仑的镇静效果进行详细评价,从而进一步优化和完善机械通气脓毒症患者的镇静方案。方法:选取2020年1月-2021年12月我院98例机械通气脓毒症患者作为研究对象,将入选患者随机分为观察组(49例)和对照组(49例),观察组患者采用舒芬太尼联合咪达唑仑镇静,对照组患者则采用咪达唑仑镇静,观察两组患者镇静前后免疫功能、细胞因子水平的变化及临床效果。结果:两组镇静后24 h和72 h的CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)水平均明显上升,差异有统计学意义(P<0.05);镇静后24 h观察组CD4^(+)、CD8^(+)水平均优于对照组,差异有统计学意义(t=7.595,13.621,均P<0.05);镇静72 h观察组CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)水平上升均优于对照组,差异有统计学意义(t=6.525,19.338,11.756,均P<0.05);镇静后24 h观察组TNF-α、IL-10较对照组明显下降,差异有统计学意义(t=12.571,5.713,均P<0.05);在镇静后72 h观察组TNF-α、IL-1、IL-6及IL-10较对照组均明显下降,差异有统计学意义(t=10.389,7.338,7.101,21.013,均P<0.05)。镇静后2 h观察组SpO2、Ramsay镇静评分优于对照组,差异有统计学意义(t=8.481,13.451,均P<0.05),且两组MAP、HR比较差异无统计学意义(P>0.05)。结论:舒芬太尼联合咪达唑仑镇静能更好地降低应激反应水平,调整免疫功能及减轻炎症反应强度,临床效果均优于单独使用咪达唑仑,且不增加不良反应,是机械通气脓毒症患者比较良好的镇静方案。

Objective: To further optimize and improve the sedation program of sepsis patients with mechanically ventilation by evaluating the sedative effect of sufentanil combined with midazolam.Methods: A total of 98 patients with sepsis under mechanical ventilation in our hospital from January 2020 to December 2021 were selected as the research objects,and those patients were randomly divided into the observation group(49 cases)and the control group(49 cases).The observation group was treated with sufentanil combined with midazolam for sedation,and the control group was only uesd midazolam.The changes of immune function,cytokine levels and clinical effects were observed in the two groups before and after sedation.Results: The levels of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the two groups were elevated at 24 h and 72 h after sedation(P<0.05).However,the levels of CD4^(+)and CD8^(+)in the observation group were lower than those in the control group at 24 h after sedation(t=7.595,13.621,P<0.05);the levels of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were significantly decreased in the observation group at 72 hours after sedation(t=6.525,19.338,11.756,P<0.05).Additionally,TNF-αand IL-10 in the observation group were significantly lower than those in the control group at 24 h after sedation(t=12.571,5.713,P<0.05).Compared with the control group,TNF-α,IL-1,IL-6 and IL-10 in the observation group was significantly decreased at 72 h after sedation(t=10.389,7.338,7.101,21.013,P<0.05).The SpO_(2) and Ramsay sedation scores of the observation group were better than those of the control group at 2 h after sedation(t=8.481,13.451,P<0.05),and there was no difference in MAP and HR between the two groups(P>0.05).Conclusion: Sufentanil combined with midazolam can better reduce the stress response,adjust immune function and down-regulate the inflammation.The clinical effect of sufentanil combined with midazolam is better than that of midazolam alone without increasing adverse reactions,which is a good sedation program for sepsis patients under mechanical ventilation.