摘要
目的观察重症监护病房(intensive care unit,ICU)机械通气长时镇静患者使用右美托咪定与咪达唑仑镇静心血管不良事件发生情况,对其安全性进行评价。方法选择2014年1月—2015年12月入住ICU年龄≥18周岁的机械通气时间≥48 h的患者,将其随机分成右美托咪定镇静组(D组)和咪达唑仑镇静组(M组)。观察镇静期间心血管等不良事件发生情况。结果 D组144例,M组143例。D组以心率减慢为突出表现,虽心率<50次/min需要异丙肾上腺素处理者(4.86%)较M组(6.29%)少,但差异无统计学意义(P=0.681)。D组血压下降(40.28%)、心动过速(18.75%)、心律失常(16.67%)、28 d病死率(22.22%)均低于M组(72.73%、41.96%、34.97%、42.66%),差异均有统计学意义(P<0.01)。两组未见心搏骤停、窦性停搏、高血压、高血糖、低血糖等表现。结论机械通气患者右美托咪定长时镇静是安全的,心血管不良事件中除心率减慢为突出表现外,其他较咪达唑仑传统镇静明显减少,28 d病死率更低,机械通气时间无明显延长,住ICU天数稍延长。
Objective To observe the incidence rate of cardiovascular adverse events and evaluate the safety of dexmedetomidine or midazolan sedation in patients with long-term mechanical ventilation in intensive care unit（ICU）.Methods From January 2014 to December 2015, patients admitted to ICU aged ≥18 years with mechanical ventilation time ≥48 hours were randomly divided into dexmetomidine group（group D） and midazolam group（group M）. Adverse events such as cardiovascular events during sedation were observed. Results There were 144 cases in group D and 143 cases in group M. Slow heart rate was the prominent manifestation in group D. The incidence of heart rate 50 beats per minute in group D（4.86%） was less than that in group M（6.29%）, but there was no statistical difference（P=0.681）. Group D had lower blood pressure（40.28% vs. 72.73%）, tachycardia（18.75% vs. 41.96%）, arrhythmia（16.67% vs. 34.97%） and 28-day mortality（22.22% vs. 42.66%） than those in group M（P〈0.01）. No cardiac arrest, sinus arrest, hypertension,hyperglycemia, or hypoglycemia were found in the two groups. Conclusion The long-term sedation of dexmetidine in patients with mechanical ventilation is safe; in cardiovascular adverse events, the 28-day mortality is lower than that of traditional midazolam sedation, and the duration of mechanical ventilation is no longer than that of traditional midazolam sedation, with slightly longer ICU length of stay.
作者
杨明全
刘扬
周洁
YANG Mingquan;LIU Yang;ZHOU Jie(Intensive Care Unit,the First Peoples＇ Hospital of Zigong,Zigong,Sichuan 643000,P.R.China)
出处
《华西医学》
CAS
2018年第8期994-998,共5页
West China Medical Journal
基金
四川省卫生厅科研课题(120003)
