右美托咪啶对AECOPD有创机械通气患者免疫炎性反应及临床疗效的影响

Effects of Dexmedetomidine on Immune Inflammatory Response and Clinical Efficacy in Patients with AECOPD with Invasive Mechanical Ventilation

目的分析行有创机械通气的慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者采用右美托咪啶镇静治疗对免疫炎性反应及临床疗效的影响。方法选择2019年11月~2022年4月徐州市第一人民医院收治的有创机械通气AECOPD患者105例,按照随机数字表法分为RF组、MR组和DR组,每组各35例,RF组患者采用瑞芬太尼镇痛,MR组患者采用咪达唑仑联合瑞芬太尼镇痛镇静,DR组患者采用右美托咪啶联合瑞芬太尼镇痛镇静。比较3组患者治疗后免疫炎性反应、氧合指数(oxygenation index,OI)、机械通气时间、住ICU时间和不良反应发生等情况。结果DR组CD4^(+)T淋巴细胞(CD4^(+))、CD8^(+)T淋巴细胞(CD8^(+))、CD4^(+)/CD8^(+)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C reactive protein,CRP)等指标变化均优于RF组和MR组(P<0.05),DR组OI改善优于RF组和MR组(P<0.05)。DR组机械通气时间、住ICU时间低于RF组和MR组(P<0.05),3组患者心动过缓、低血压、呼吸抑制发生率比较,差异均无统计学意义(P均>0.05),MR组谵妄发生率高于RF组和DR组(P<0.05)。结论对于有创机械通气的AECOPD患者,采用右美托咪啶镇静治疗能够有效改善其病情发展,提高免疫功能,缩短ICU住院时间,具有较高的临床应用价值。

Objective To analyze the effect of dexmedetomidine on immune inflammatory response and clinical efficacy in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with invasive mechanical ventilation.Methods A total of 105 AECOPD patients with invasive mechanical ventilation admitted to Xuzhou First People′s Hospital from November 2019 to April 2022 were divided into RF group,MR Group and DR group according to random number table method,with 35 cases in each group.Patients in RF group were given remifentanil for analgesia,Patients in MR group were given midazolam combined with remifentanil for analgesia and sedation,and Patients in DR group were given dexmedetomidine combined with remifentanil for analgesia and sedation.The immune inflammatory reaction,oxygenation index(OI),mechanical ventilation time,ICU stay time and adverse reactions of the three groups were compared.Results CD4^(+)T lymphocytes(CD4^(+)),CD8^(+)T lymphocytes(CD8^(+)),CD4^(+)/CD8^(+),interleukin-6(IL-6),and tumor necrosis factor-α,C reactive protein(CRP)in DR group were better than those in RF group and MR group(P<0.05),and the improvement of OI in DR group was better than that in RF group and MR group(P<0.05).The duration of mechanical ventilation and ICU stay time in DR group were lower than those in RF group and MR group(P<0.05).There was no significant difference in the incidence of bradycardia,hypotension and respiratory depression among the three groups(P>0.05).The incidence of delirium in MR group was higher than that in RF group and DR group(P<0.05).Conclusion For AECOPD patients with invasive mechanical ventilation,the use of dexmedetomidine for sedation can effectively improve the development of the disease,improve the immune function,and shorten the length of stay in ICU,which has high clinical application value.