右美托咪定用于重症肺炎患儿机械通气的研究

Study of dexmedetomidine for mechanical ventilation in patients with severe pneumonia

目的:探讨右美托咪定用于重症肺炎患儿机械通气的镇静效果及安全性。方法:将接受机械通气治疗的重症肺炎患儿随机分为4组,分别为小剂量右美托咪定组[Ds组,0.3μg/(kg·h),47例]、大剂量右美托咪定组[Dm组,0.7μg/(kg·h),45例]、小剂量咪达唑仑组[Ms组,2μg/(kg·min),48例]和大剂量咪达唑仑组[Mm组,5μg/(kg·min),49例]。观察各组镇静指标、机械通气指标、生命体征变化、不良反应发生率。结果:(1)各组镇静情况比较:4组达镇静目标时间、停药后苏醒时间、镇静评分、需追加药物人数比较差异有统计学意义(P<0.05),Dm组达镇静目标时间最快,Ds组及Dm组均较Ms组、Mm组更快苏醒,Ds组、Dm组、Ms组均可维持适宜镇静评分,Dm组需追加药物比例最低,Ms组需追加药物比例最高;(2)机械通气情况比较:4组患儿机械通气时间、拔管时间比较差异有统计学意义(P<0.05),Dm组机械通气时间最短,Ds组及Dm组机械通气时间均要低于Ms组、Mm组;Ds组拔管时间最短,Ds组及Dm组拔管时间均要短于Ms组和Mm组;4组患儿机械通气前、机械通气12h的氧合情况比较差异无统计学意义(P>0.05),机械通气24、36、48h氧合情况比较差异有统计学意义(P<0.05);(3)4组患儿镇静前心率、呼吸频率、平均动脉压比较差异无统计学意义(P>0.05),其后T1、T2、T3、T4时间点心率比较差异有统计学意义(P<0.05),Dm组心率下降最明显(P<0.05);T1、T2、T3、T4时间点呼吸频率比较差异有统计学意义(P<0.05);4组患儿在不同时间点平均动脉压相比均差异无统计学意义(P>0.05);(4)4组患儿心动过缓、低血压发生率比较差异无统计学意义(P>0.05),4组患儿谵妄发生率比较差异有统计学意义(P<0.05),Mm组谵妄发生率最高(P<0.05)。结论:右美托咪定用于机械通气的重症肺炎患儿,可以达到适宜的镇静效果,停药后能迅速苏醒、拔管,有效减少机械通气时间,且不良反应发生率低。右美托咪定镇静是PICU内重症肺炎患儿机械通气的优先选择。

Objective:To investigate the sedative effect and safety of dexmedetomidine for mechanical ventilation in patients with severe pneumonia.Method:Patients with severe pneumonia who underwent mechanical ventilation were randomly divided into four groups:low-dose dexmedetomidine group[Ds group,0.3μg/(kg·h),n=47],high-dose dexmedetomidine group[Dm group,0.7μg/(kg·h),n=45],low-dose midazolam group [Ms group,2μg/(kg·min),n=48]and high-dose midazolam group[Mm group,5μg/(kg·min),n=49].The sedation index,mechanical ventilation index,vital signs and adverse reactions were observed.Result:(1)Comparison of sedation in each group:the difference in the sedation target time,the recovery time after cessation of medication,the sedation score and the number of patients requiring additional drugs were statistically significant(P<0.05).Dm group had the fastest sedation target time.Ds and Dm groups were quicker than Ms and Mm groups with respect to resuscitation.Ds,Dm and Ms groups were able to maintain a suitable sedation score.Dm group had the lowest proportion of additional drugs,and Ms group had the highest proportion of additional drugs.(2)Comparison of mechanical ventilation:the difference in mechanical ventilation time and extubation time between the four groups was statistically significant(P<0.05).Dm group had the shortest mechanical ventilation time.Ds and Dm groups were lower than Ms and Mm groups in terms of the mechanical ventilation time.Ds group had the shortest extubation time.On this regard,Ds and Dm groups were shorter than Ms and Mm groups.There was no significant difference in the oxygenation before mechanical ventilation and in mechanical ventilation for 12 hours between the four groups(P>0.05).The difference of oxygenation in mechanical ventilation for 24 h,36hand 48 hwas statistically significant(P<0.05).(3)There was no significant difference in anterior heart rate,respiratory rate and mean arterial pressure between the four groups(P>0.05).There was a statistically significant difference in the dim sum rate between T1,T2,T3 and T4(P<0.05).The most significant decrease in heart rate occured in Dm group(P <0.05).The difference in RR between T1,T2,T3 and T4was statistically significant(P<0.05).There was no significant difference in MAP between the four groups at different time points(P>0.05).(4)There was no statistically significant difference in the incidence of bradycardia and hypotension in the four groups(P>0.05).The incidence of sputum in the four groups was statistically significant(P<0.05),and the incidence of sputum in Mm group was the highest(P<0.05).Conclusion:Dexmedetomidine for patients with severe pneumonia who underwent mechanical ventilation can achieve a suitable sedative effect.After suspension,patients can quickly wake up and extubate.This effectively reduces the time of mechanical ventilation,and the incidence of adverse reactions is low.Dexmedetomidine sedation is a preferred option for mechanical ventilation in patients with severe pneumonia in the PICU.