右美托咪定与丙泊酚对ICU择期术后机械通气患者血流动力学、术后谵妄及血清IL-6、NLR的影响

Effects of dexmedetomidine and propofol on hemodynamics,postoperative delirium and serum IL⁃6 and NLR in patients with mechanical ventilation after elective surgery in ICU

目的探讨右美托咪定与丙泊酚对ICU择期术后机械通气患者血流动力学、术后谵妄及血清白细胞介素(IL)-6、中性粒细胞/淋巴细胞比值(NLR)的影响。方法选取2019年1月至2021年2月收治于中山市第五人民医院的102例ICU择期术后机械通气患者作为研究对象,按随机法分为右美托咪定组(A组)与丙泊酚组(B组),各51例。两组均接受镇痛治疗,在此基础上A组给予右美托咪啶1.0μg/kg微量泵静脉输注10 min后以0.6μg/kg/h的维持输注;B组给予丙泊酚1.0~3.0 mg/kg/h维持。比较两组镇静效果、各时间点血流动力学[平均动脉压(MAP)、血氧饱和度(SpO_(2))、心率(HR)]、血清IL-6、NLR水平变化情况。统计两组术后3 d谵妄发生率、ICU滞留时间、机械通气时间、血管活性药物使用情况、心率减慢事件、呼吸抑制发生次数。结果两组目标镇静水平达标率、补充镇静次数比较差异无统计学意义(P>0.05)。两组T0、T3时MAP、HR比较差异无统计学意义(P>0.05);T1、T2时点两组MAP均下降,HR均升高,且A组水平更优,差异有统计学意义(均P<0.05)。两组各时间点SpO_(2)比较差异无统计学意义(P>0.05)。两组T0时血清IL-6、NLR水平比较差异无统计学意义(P>0.05);T1、T2、T3各时点两组血清IL-6、NLR均下降,且A组水平更低,差异有统计学意义(P<0.05)。A组术后3 d谵妄发生率、呼吸抑制发生率低于B组,ICU滞留时间、机械通气时间短于B组,差异有统计学意义(均P<0.05)。两组血管活性药物使用时间、心率减慢事件差异无统计学意义(P>0.05)。结论与丙泊酚相比,右美托咪啶应用于ICU择期术后机械通气患者对其血流动力学影响较小,能降低术后谵妄发生风险,减轻炎症反应。

Objective To investigate the effects of dexmedetomidine and propofol on hemodynamics,postoperative delirium and serum interleukin 6(IL-6)and neutrophil/lymphocyte ratio(NLR)in patients with mechanical ventilation after elective surgery in ICU.Methods A total of 102 patients with ICU elective post-operative mechanical ventilation admitted to the Fifth People's Hospital of Zhongshan City from January 2019 to February 2021 were selected as the research subjects.They were randomly divided into a dexmedetomidine group(group A)and a propofol group(group B),with 51 cases in each group.Both groups received analge-sic treatment.On this basis,group A was given dexmedetomidine 1.0μg/kg micro-pump intravenous infusion for 10 min and then maintained at 0.6μg/kg/h.Group B was given propofol 1.0~3.0 mg/kg/h for maintenance.The sedative effect,hemodynamics[mean arterial pressure(MAP),oxygen saturation(SpO_(2)),heart rate(HR)],serum IL-6 and NLR levels at each time point were compared between the two groups.The incidence of delirium at 3 days after operation,ICU retention time,mechanical ventilation time,vasoactive drug use,heart rate slowing events and respiratory depression were counted in the two groups.Results There was no significant difference in the target sedation level compliance rate and the number of supplementary sedations be-tween the two groups(P>0.05).There was no significant difference in MAP and HR between the two groups at T0 and T3(P>0.05).At T1 and T2,MAP decreased and HR increased in both groups,and the level of group A was better,the difference was statistically significant(P>0.05).The levels of serum IL-6 and NLR in the two groups decreased at T1,T2 and T3,and the levels in group A were lower,the differences were statis-tically significant(P<0.05).The incidence of delirium and respiratory depression at 3 days after operation in group A was lower than that in group B,and the ICU stay time and mechanical ventilation time were shorter than those in group B(P<0.05).There was no significant difference in the use time of vasoactive drugs and heart rate slowing events between the two groups(P>0.05).Conclusion Compared to propofol,dexmedeto-midine has less effect on hemodynamics in patients with mechanical ventilation after elective surgery in ICU,which can reduce the risk of postoperative delirium and reduce the inflammatory response.