右美托咪定在慢性阻塞性肺疾病需机械通气患者镇静中的应用

目的探讨右美托咪定用于慢性阻塞性肺疾病(COPD)需机械通气患者镇静的有效性及安全性。方法 COPD急性发作期需机械通气患者50例,随机分为2组,每组25例。右美托咪定组负荷剂量右美托咪定1μg·kg~(-1),维持量0.2～0.7μg·kg~(-1)·h~(-1);丙泊酚组负荷剂量丙泊酚1 mg·kg~(-1),维持量0.5～4.0 mg·kg~(-1)·h~(-1)。根据Riker镇静-躁动评分(SAS)调整镇静药物剂量,记录SAS、达SAS 2～3分时间和苏醒时间,并比较2组重症监护病房(ICU)住院时间、机械通气时间,呼吸抑制、心动过缓和谵妄发生率。结果右美托咪定与丙泊酚都能使患者达到镇静目标评分且达标时间无显著差异(P>0.05),右美托咪定组患者更易唤醒并保持安静。右美托咪定组ICU住院时间和机械通气时间(6.4±1.2)d和(3.2±1.0)d]均短于丙泊酚组(8.3±1.4)d和(5.1±2.3)d,P<0.05],呼吸抑制和谵妄发生率(4%和4%)低于丙泊酚组(32%和28%),差异有显著意义(P<0.05)。2组心动过缓发生率无显著差异(P>0.05)。结论右美托咪定用于COPD需机械通气患者镇静效果满意,可缩短ICU住院及机械通气时间,且安全性高。

Feasibility of dexmedetomidine in sedation for chronic obstructive pulmonary diseases patients undergoing mechanical ventilation

AIM To investigate the sedative effect and safety of dexmedetomidine for chronic obstructive pulmonary disease(COPD) patients undergoing mechanical ventilation.METHODS Fifty COPD patients undergoing mechanical ventilation were enrolled and divided into dexmedetomidine group and propofol group randomly(25 in each).The loading dose and maintenance dose of dexmedetomidine was 1μg·kg~(-1) and 0.2 - 0.7μg ? kg~(-1)?h~(-1),and 1 mg·kg~(-1) and 0.5 - 4.0 mg·kg.(-1)·h~(-1) for propofol.The drug dose was adjusted according to Riker sedation-agitation scale(SAS).The SAS,revive time and the time when the SAS reach 2-3 were recorded.The length of ICU stay,ventilator weaning time,and the incidences of bradycardia,respiratory depression and delirium were compared between two groups.RESULTS All patients reached targeted sedation level and there was no difference in time between two groups.Dexmedetomidine-treated patients were more likely to wake up and keep quiet.The length of ICU stay and ventilator weaning time of the dexmedetomidine group were shorter compared with those of the propofol group((6.4±1.2) and(3.2±1.0) d vs.(8.3±1.4) and(5.1±2.3) d,P<0.05).The incidences of delirium and respiratory sepression of the dexmedetomidine group were lower than those of the propofol group(4%and 4%vs.32%and 28%,P<0.05) and there was no significantly difference in the incidence of bradycardia(P>0.05).CONCLUSION Dexmedetomidine is an effective and safety sedative for COPD patients undergoing mechanical ventilation and can reduce the length of ICU stay and ventilator weaning time.