慢性阻塞性肺疾病急性加重机械通气患者早期目标导向镇静的临床研究

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摘要目的研究慢性阻塞性肺疾病急性加重（AECOPD）机械通气患者使用早期目标导向镇静的临床方法。方法选择2015年7月~2017年5月于四川绵阳四〇四医院重症医学科治疗的AECOPD机械通气患者90例，采用随机数字表法分为对照组（标准镇静方案）和观察组（右美托咪定早期目标导向镇静），每组各45例，镇静目标RASS评分为-2~1分，首剂负荷及维持剂量均按照说明书进行。比较两组达到理想镇静水平时间、患者唤醒时间、ICU住院时间、机械通气时间、不良反应情况及炎症因子水平。结果两组达到理想镇静水平时间差异无统计学意义（P > 0.05）。观察组停药后唤醒时间明显短于对照组（P < 0.05）。两组ICU住院时间差异无统计学意义（P > 0.05），但在机械通气时间方面观察组短于对照组（P < 0.05）。观察组不良反应发生率低于对照组，差异有统计学意义（P < 0.05）。两组患者镇定24 h时血浆TNF-α水平比较差异无统计学意义（P > 0.05），观察组血浆IL-1水平低于对照组（P < 0.05）。结论对AECOPD机械通气患者施行早期目标导向镇静是可行的，镇静效果满意，可缩短ICU住院及机械通气时间，不良反应发生率较低。

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	王洪州邓丽娟▲ 汤秦程森中

关键词 ：右美托咪定, 镇静, 慢性阻塞性肺疾病急性加重, 早期目标导向性

Abstract：Objective To study the clinical application of early goal-directed sedation in mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods 90 patients with AECOPD given mechanical ventilation from July 2015 to May 2017 in Intensive Care Unit of Sichuan Mianyang 404th Hospital were randomly divided into control group (standard sedation regimen) and observation group (Dexmedetomidine early goal-directed sedation), 45 cases in each group. Sedation target was RASS -2 to 1 points. The first dose of load and maintenance doses were carried out according to the instructions. The reaching ideal sedation time, wake-up time, ICU hospitalization time, duration of mechanical ventilation, adverse reactions and levels of inflammatory cytokine were compared between the two groups. Results There was no significant difference between the two groups in reaching ideal sedation time (P > 0.05), but the wake-up time of the observation group was significantly shorter than the control group (P < 0.05). There was no significant difference between the two groups in ICU hospitalization time (P > 0.05), but the duration of mechanical ventilation of the observation group was significantly shorter than the control group (P < 0.05). The adverse reactions of the observation group were lower than those of the control group (P < 0.05). There was no statistically significant difference in plasma TNF-α level between the two groups when they were stabilized by 24 h (P > 0.05), however, the level of plasma IL-1 in the observation group was lower than that of the control group at the stabilization of 24 h (P < 0.05). Conclusion It is feasible to perform early goal-directed sedation in mechanical ventilation AECOPD patients with satisfactory sedative effect, which can shorten the duration of ICU hospitalization and reduce the adverse reactions.

Key words： Dexmedetomidine Sedation Acute exacerbation of chronic obstructive pulmonary disease Early goal-directed

基金资助:四川省医学会重症医学专项课题[2015ZZ010（GR）]。

通讯作者: ▲通讯作者

作者简介: 王洪州（1976.8-），硕士，副主任医师，主要从事呼吸危重症及机械通气研究。

引用本文:

王洪州邓丽娟▲ 汤秦程森中 . 慢性阻塞性肺疾病急性加重机械通气患者早期目标导向镇静的临床研究[J]. 中国医药导报, 2017, 14(28): 74-77.
WANG Hongzhou DENG Lijuan▲ TANG Qin CHENG Senzhong. Clinical study of early goal-directed sedation in mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease. 中国医药导报, 2017, 14(28): 74-77.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I28/74

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