右美托咪定对机械通气脓毒症患者炎性因子和预后的影响

Effects of dexmedetomidine on inflammatory factors and outcomes in mechanically ventilated sepsis patients

目的探讨右美托咪定对机械通气脓毒症患者炎性因子和预后的影响。方法脓毒症行机械通气患者60例,随机分为右美托咪定组31例和咪达唑仑组29例,分别予右美托咪定和咪达唑仑,保持患者状态于RASS评分-2~0分。两组患者分别于用药前(T0)及用药后3 d(T1)、7 d(T2)时抽取静脉血检测血清CRP、PCT、TNF-α的水平。比较两组患者接受镇静治疗后第7天时APACHEⅡ评分和SOFA评分,并统计两组患者不良反应发生率和28天病死率。结果治疗后两组患者CRP、PCT及TNF-α水平均显著下降,与治疗前比较差异有统计学意义(P<0.05);两组患者治疗后APACHEⅡ评分及SOFA评分较治疗前明显改善,差异有统计学意义(P<0.05);治疗后右美托咪定组患者各时间点PCT、CRP、TNF-α水平以及APACHEⅡ评分、SOFA评分明显低于咪达唑仑组,差异有统计学意义(P<0.05)。两组患者不良事件发生率及28 d病死率比较差异无统计学意义(P>0.05)。结论右美托咪定和咪达唑仑对机械通气脓毒症患者有良好的抗炎作用,右美托咪定抗炎作用较咪达唑仑强。

Objective To investigate the effects of dexmedetomidine(Dex)on inflammatory factors and outcomes in mechanically ventilated sepsis patients.Methods Sixty mechanically ventilated sepsis patients were randomly divided into the dexmedetomidine group(n=31)and the midazolam group(n=29),receiving either dexmedetomidine or midazolam to maintain a RASS score of-2 to 0.Venous blood samples were collected before treatment(T0),and at 3 days(T1)and 7 days(T2)post-treatment to measure serum levels of CRP,PCT,and TNF-α.APACHEⅡand SOFA scores were compared between the two groups on the 7th day of sedation.Additionally,the incidence of adverse reactions and the 28-day mortality rate were recorded.Results CRP,PCT,and TNF-αlevels significantly decreased in both groups post-treatment,with statistically significant differences compared to pre-treatment levels(P<0.05).Both APACHEⅡand SOFA scores showed significant improvement post-treatment in both groups(P<0.05).The declines of CRP,PCT,TNF-α,and APACHEⅡand SOFA scores were significantly greater in the dexmedetomidine group compared to the midazolam group(P<0.05).There was no statistically significant difference in the incidence of adverse events and the 28-day mortality rate between the two groups(P>0.05).Conclusion Both dexmedetomidine and midazolam have effective anti-inflammatory effects in mechanically ventilated sepsis patients,with dexmedetomidine showing superior efficacy.