摘要
目的探究右美托咪啶在重症患者机械通气撤离呼吸机中的应用效果。方法前瞻性选择2018年7月至2019年7月佛山市南海区第四人民医院重症医学科收治的100例重症患者作为研究对象,按照随机数表法分为三组,分别采用不同的药物治疗,其中右美托咪定组34例、丙泊酚组35例和不采用任何药物的对照组31例。比较三组患者分别在机械通气撤机前4 h (T1)、撤机前2 h (T2)及撤机时(T3)时的呼吸功能[呼吸频率(RR)、血氧饱和度(SaO2)、氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(RI)]、撤机参数[最大吸气压(PImax)、气道闭合压(P0.1)、呼吸用力指数(CORE)、浅快呼吸指数(RSBI,f/VT)]状况以及血流动力学变化[心率(HR)、平均动脉压(MAP)]。采用镇静和躁动评分(SAS评分)评估三组患者的镇静效果。结果 T1时,丙泊酚组患者的RR明显低于右美托咪定组和对照组,PaCO2明显高于右美托咪定组和对照组,差异均有统计学意义(P<0.05);T1时右美托咪定组PaCO2、RR水平与对照组比较差异均无统计学意义(P>0.05);T2、T3时,三组患者的RR、SaO2、PaO2、PaCO2、RI水平两两比较,差异均无统计学意义(P>0.05);T1~T3三组患者的HR、MAP两两比较差异均无统计学意义(P>0.05);T1时,右美托咪定组患者的PImax、CORE水平明显高于丙泊酚组,差异有统计学意义(P<0.05),但T1时,丙泊酚组与对照组,右美托咪定组与对照组患者的PImax、CORE比较差异均无统计学意义(P>0.05);T2~T3时,三组患者的PImax、CORE比较,差异均有统计学意义(P>0.05);T1~T3时,三组患者的P0.1、RSBI水平比较差异均无统计学意义(P>0.05);T1~T3时,右美托咪定组与丙泊酚组和对照组的SAS评分比较差异具有统计学意义(P<0.05),且丙泊酚组与对照组的SAS评分比较差异具有统计学意义(P>0.05)。结论右美托咪定对机械通气患者撤机过程中的血流动力学、呼吸功能无明显不良影响,同时其镇静镇痛效果显著,值得临床推广应用。
Objective To investigate the application effect of dexmedetomidine in mechanical evacuation of severe patients in evacuated ventilator and provide guidance for clinical treatment of patients. Methods A total of 100 critically ill patients, who admitted to the Department of Intensive Medicine of the Fourth People’s Hospital of Nanhai District, Foshan City from July 2018 to July 2019 were prospectively selected and divided into three groups according to random number table method. The three groups were treated with different drugs, including dexmedetomidine group(n=34), propofol group(n=35) and control group without any drug(n=31). The respiratory function of the three groups of patients 4 hours before mechanical ventilation(T1), 2 hours before weaning(T2), and 0 hours(T3) before weaning from mechanical ventilation(respiratory rate [RR], blood oxygenation Saturation [SaO2], partial pressure of oxygen [PaO2],partial pressure of carbon dioxide [PaCO2], oxygenation index [RI]), and weaning parameters(maximum inspiratory pressure [PImax], airway closure pressure [P0.1], respiratory force index [CORE], shallow fast breathing index [RSBI, f/VT]status), and hemodynamic changes(heart rate [HR], mean arterial pressure [MAP]) were observed and recorded. Sedation and agitation scores(SAS scores) were used to assess the sedative effects of the three groups. Results At the time of T1, the RR of patients in the propofol group was significantly lower than that of the dexmedetomidine group and the control group, and PaCO2 was significantly higher than that of the dexmedetomidine group and the control group, and the difference was statistically significant(P<0.05);there were no significant differences in PaCO2 and RR levels between the dexmedetomidine group and the control group at T1(P>0.05);at the time of T2 and T3, there was no significant difference in the RR, SaO2, PaO2, PaCO2, and RI levels among the three groups(P>0.05);there was no significant difference in HR and MAP among T1~T3 patients of the three groups(P>0.05);at the time of T1, the PImaxand CORE levels of patients in the dexmedetomidine group were significantly higher than those in the propofol group, and the difference was statistically significant(P<0.05);however, at T1, there was no statistically significant difference in PImaxand CORE between the propofol group and the control group, and between the dexmedetomidine group and the control group(P>0.05);at the time points of T2 to T3, the differences of PImaxand CORE among the three groups were statistically significant(P>0.05);at T1 to T3, there were no significant differences in the levels of P0.1 and RSBI among the three groups(P>0.05);from T1 to T3, the SAS scores of the dexmedetomidine group were significantly different with those in the propofol group and the control group(P<0.05), and there was significant difference in the SAS scores between the propofol group and the control group(P>0.05). Conclusion Dexmedetomidine has no obvious adverse effects on hemodynamics and respiratory function during mechanical evacuation, and its sedative and analgesic effect is significant,which is worthy of clinical application.
作者
柯颜基
吴智成
麦梨欢
刘雄玉
郑毅华
KE Yan-ji;WUZhi-cheng;MAI Li-huan;LIU Xiong-yu;ZHENG Yi-hua(Department of Critical Medicine,the Fourth People's Hospital of Nanhai District,Foshan 528211,Guangdong,CHINA)
出处
《海南医学》
CAS
2020年第9期1144-1148,共5页
Hainan Medical Journal
基金
广东省佛山市科技计划项目(编号:2017AB000452)。
关键词
右美托咪定
撤离呼吸机
镇静镇痛
重症
机械通气
Dexmedetomidine
Evacuation of ventilator
Sedation and analgesia
Severe
Mechanical ventilation
