右美托咪啶与咪达唑仑对慢性阻塞性肺疾病急性加重期机械通气患者镇静的比较研究

目的 研究右美托咪啶与咪达唑仑用于慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者镇静的效果及安全性.方法 选择需要气管插管机械通气的AECOPD患者68例,根据患者入住时的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分水平随机分为右美托咪啶组(34例)和咪达唑仑组(34例)进行镇静治疗.右美托咪啶组予负荷剂量1.0 μg/kg,以0.2～0.8 μg·kg-1 ·h-1的剂量维持；咪达唑仑组予负荷剂量0.05 mg/kg,以0.06 ～0.2 mg·kg-1·h-1剂量维持；使Ramsay评分控制在3～4分.比较两组镇静起效时间、停用镇静剂后的苏醒时间、机械通气时间、拔管成功率、ICU住院时间和入ICU后28 d死亡率.同时比较镇静后呼吸抑制、循环及谵妄等不良反应的发生率.结果 两组患者年龄、性别及APACHEⅡ评分比较差异无统计学意义.与咪达唑仑比较,右美托咪啶起效迅速(49.80 ±8.20)s比(107.55 ±19.65)s,P＜0.01],苏醒时间短(18.90 ±2.30) min比(40.82±19.85) min,P＜0.01],机械通气时间短(4.9±1.6)d比(7.8±2.5)d,P＜0.01],成功脱机拔管率高(79.4％比58.8％,P＜0.01),ICU住院时间短(6.5±2.5)d比(9.6±3.4)d,P＜0.05].右美托咪啶呼吸抑制率低,血流动力学影响小,谵妄发生率低且持续时间短.两组28 d死亡率无明显差异.结论 右美托咪啶可作为AECOPD机械通气患者镇静的优先选择药物之一.

versus Midazolam for Sedation of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Underwent Mechanical Ventilation

Objective To study the sedative effects and safety of dexmedetomidine and midazolam for acute exacerbate of chronic obstructive pulmonary disease （AECOPD） underwent mechanical ventilation. Methods 68 AECOPD patients underwent mechanical ventilation were enrolled and randomly divided into a dexmedetomidine group （n = 34） and a midazolam group （n = 34） by acute physiology and chronic health evaluation Ⅱ（ APACHE Ⅱ） score. The patients in the dexmedetomidine group were given a loading dose （ 1 μg/kg） and then maintained with 0. 2-0. 8 mg·kg-1·h-1. The patients in the midazolam group were given a loading dose （0. 05 mg/kg） and then maintained with 0. 06-0. 2 mg·kg-1·h-1. Sedation level was assessed by Ramsay score and maintained a Ramsay score of 3-4. The sedation onset time, disable sedatives wake time, duration of mechanical ventilation, extubation success rate, ICU length of stay, and 28 days mortality after admission to the ICU were compared between two groups. And calmer respiratory depression, circulatory and delirium adverse reactions incidence were also compared. Results The differences in patients＇ age, gender, and APACHE Ⅱ score between two groups were not significant （ P 〉 0. 05 ）. Compared with the midazolam group, the dexmedetomidine group had more rapid onset of sedation （49. 80± 8.20） s vs. （ 107.55 ±19.65） s, P 〈 0. 01 ], shorter wake-up time （ 18.90±2. 30） min vs.（40. 82±19. 85） min,P 〈0. 01],shorter duration of mechanical ventilation （4. 9 ±1.6）d vs. （7.8 ±2. 5）d, P 〈0. 01 ] ,higher successful extubation rate （79. 41% vs. 58. 82% ,P 〈0. 01 ） ,and shorter ICU length of stay （6. 5 ±2. 5 ） d vs. （ 9. 6±3.4 ） d, P 〈 0. 05 ]. Dexmedetomidine had lower respiratory depression rate,little effects on hemodynamies, lower occurrence and short duration of delirium. Conclusion It is highly recommended that dexmedetomidine be used for sedation in AECOPD patients with mechanical ventilation.