不同镇静药物对无创正压通气心力衰竭患者血流动力学及血气分析影响临床研究

Clinical study on the effect of different sedatives on hemodynamics and blood gas analysis in non-invasive positive pressure ventilation patients with heart failure

目的观察不同镇静药物对无创正压通气(NPPV)心力衰竭患者血流动力学及血气分析的影响。方法选择2020年1月至2022年1月该院确诊并进行NPPV治疗的90例心力衰竭患者作为研究对象,采用随机抽签法将患者分入A、B、C组,每组30例。A组给予右美托咪定镇静药物,B组给予咪达唑仑镇静药物,C组给予丙泊酚镇静药物。观察记录各组患者NPPV时间、重症监护病房(ICU)治疗时间、气管插管率、28 d内病死率、不良反应发生率及镇静后6、24、48 h的中心静脉压(CVP)、心率(HR)、N-末端B型利钠肽原(Nt-proBNP)、平均动脉压(MAP)、动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))、动脉血二氧化碳分压(PaCO_(2))变化情况。结果A组患者NIPPV时间、气管插管率、ICU治疗时间、停药后清醒时间均明显短于B、C组,差异均有统计学意义(P<0.05),但B、C组NIPPV时间、气管插管率、ICU治疗时间、停药后清醒时间比较,差异均无统计学意义(P>0.05)。A组患者镇静后6、24、48 h时HR、CVP、Nt-proBNP、MAP水平均明显低于B、C组,差异均有统计学意义(P<0.05);但B、C组镇静后6、24、48 h时HR、CVP、Nt-proBNP、MAP水平比较,差异均无统计学意义(P>0.05)。A组患者镇静后6、24、48 h时SpO_(2)、PaO_(2)水平均明显高于B、C组,PaCO_(2)水平明显均低于B、C组,差异均有统计学意义(P<0.05),但B、C组镇静后6、24、48 h时SpO_(2)、PaO_(2)、PaCO_(2)水平比较,差异均无统计学意义(P>0.05)。A组患者并发症发生率(16.67%)与B组(26.67%)、C组(30.00%)之间比较,差异均无统计学意义(P>0.05)。结论右美托咪定、咪达唑仑、丙泊酚对NPPV心力衰竭患者镇静时的不良反应发生率相当,但右美托咪定可更有效缩短NPPV时间、ICU治疗时间及停药后清醒时间,降低气管插管率,同时较快改善血流动力学状况、心功能,且更显著地纠正低氧血症。

Objective To observe the effects of different sedatives on hemodynamics and blood gas analysis in patients with heart failure with noninvasive positive pressure ventilation(NPPV).Methods A total of 90 patients with heart failure diagnosed and treated with NPPV in this hospital from January 2020 to January 2022 were selected as research objects,and randomly divided into groups A,B and C,with 30 patients in each group.The group A was given dexmedetomidine,the group B was given midazolam,and the group C was given propofol.The NPPV time,ICU treatment time,endotracheal intubation rate,mortality within 28 days,incidence of adverse reactions,central venous pressure(CVP),changes of heart rate(HR),N-terminal B-type natriuretic peptide(Nt-proBNP),mean arterial pressure(MAP),arterial oxygen partial oxygen saturation(SpO_(2)),and arterial partial carbon dioxide pressure(PaCO_(2))at 6,24 and 48 hours after sedation were observed and recorded in each group.Results The NIPPV time,endotracheal intubation rate,ICU treatment time and wake time after drug withdrawal in the group A were significantly shorter than those in groups B and C,the differences were statistically significant(P<0.05),but there were no statistical significances in NIPPV time,endotracheal intubation rate,ICU treatment time and wake time after drug withdrawal between groups B and C(P>0.05).The levels of HR,CVP,Nt-proBNP and MAP in group A were significantly lower than those in groups B and C at 6,24 and 48 hours after sedation,the differences were statistically significant(P<0.05).However,there were no statistical significances in the levels of HR,CVP,Nt-proBNP and MAP between groups B and C at 6,24 and 48 hours after sedation(P>0.05).SpO_(2),PaO_(2)in the group A were significantly higher than those in groups B and C at 6,24 and 48 hours after sedation,and PaCO_(2)was significantly lower than those in groups B and C,the differences were statistically significant(P<0.05),but there were no statistical significances in SpO_(2),PaO_(2)and PaCO_(2)between groups B and C at 6,24 and 48 hours after sedation(P>0.05).There was no significant difference in the incidence of complications between the group A(16.67%),group B(26.67%)and group C(30.00%)(P>0.05).Conclusion Dexmedetomidine,midazolam and propofol have the same incidence of adverse reactions during sedation in patients with NPPV heart failure,but dexmedetomidine is more effective in reducing the duration of NPPV,endotracheal intubation rate,ICU treatment time and wake time after drug withdrawal,and can improve hemodynamic status and cardiac function faster,and correct hypoxemia more significantly.