以右美托咪定为基础早期目标导向镇静策略对脓毒症患者胃肠功能的影响

目的探讨以不同镇静药物为基础实现早期目标导向镇静策略（EGDS）对脓毒症患者胃肠功能的影响。 方法选取2017年1月至2019年2月期间连续收治于诸暨市中医医院重症医学科（ICU）的脓毒症患者，随机将其分为3组：Dex组（31例），Mid组（30例），Pro组（32例）。3组患者均在酒石酸布托啡诺充分镇痛的基础上，采取EGDS，Dex组予右美托咪定镇静，Mid组予咪达唑仑镇静，Pro组予丙泊酚镇静，记录3组患者第1天（T1）、第3天（T3）、第7天（T7）的胃肠损伤指标［二胺氧化酶（DAO）、肠脂肪酸结合蛋白（IFABP）和急性胃肠损伤（AGI）分级］及镇痛药物日均剂量、住院期间镇静镇痛日均费用、机械通气时间、住ICU时间、血管活性药物使用率、谵妄发生率。 结果（1）胃肠损伤指标：Dex组较Mid组、Pro组明显降低，各指标交互作用、组间及时间点差异多有统计学意义（P<0.05）；除外血清DAO值组间和时点交互，差异无统计学意义（P>0.05）。（2）AGI分级：Dex组较Mid组、Pro组明显降低，差异有统计学意义（P<0.05）。（3）Dex组较Mid组、Pro组镇静药物日均用量、镇静镇痛日均费用、机械通气时间、谵妄发生率、28 d病死率明显降低，差异有统计学意义（P<0.05）；阿托品和异丙肾的使用率，Dex组较Mid组、Pro组明显升高，差异有统计学意义（P<0.05）；而去甲肾上腺素的使用率，差异无统计学意义（P>0.05）。 结论右美托咪定联合酒石酸布托啡诺的镇静镇痛方案，可改善脓毒症AGI患者的胃肠功能，降低AGI分级，减少机械通气时间和谵妄的发生率。

Effect of Dexmedetomidine -based early goal-oriented sedation strategy on gastrointestinal function in patients with sepsis

ObjectiveTo investigate the effect of early goal-oriented sedation strategy on gastrointestinal function in sepsis patients with different sedatives. MethodsA randomized controlled study was conducted on patients with sepsis who were admitted to ICU of Zhuji Hospital of Traditional Chinese Medicine consecutively from January 2017 to February 2019. Sepsis patients were randomly divided into three groups: Dex group (n=31), Mid group (n=30) and Pro group (n=32). All three groups of patients adopted early goal-directed sedation (EGDS) based on the sufficient analgesia of butorphanol tartrate. Dex group was sedated with Dexmedetomidine, Mid group with Midazolam, Pro group with Propofol. Gastrointestinal indexes (DAO, IFABP and AGI grading) at day 1 (T1), day 3 (T3) and day 7 (T7) were recorded in the three groups. Average daily dose of analgesics, daily costs of sedation and analgesia during hospitalization, mechanical ventilation time, length of ICU stay, vasoactive drug usage, and delirium incidence were also recorded. Results(1) gastrointestinal injury indexes: Dex group was significantly lower than Mid group and Pro group, and the differences in the interaction between the indexes, time points and between groups were statistically significant (P<0.05). There was no significant difference between the two groups (P>0.05). (2) AGI grading: Dex group was significantly lower than Mid group and Pro group, and the difference was statistically significant (P<0.05). (3) Average daily dose of analgesics, the average daily cost of sedation and analgesia, mechanical ventilation time, delirium incidence and 28-day mortality in Dex group were significantly reduced compared with Mid group and Pro group, and the differences were statistically significant (P<0.05). The utilization rates of Atropine and Isopropyl were significantly higher in the Dex group than in the Mid group and the Pro group (P<0.05). There was no significant difference in Norepinephrine usage (P>0.05). ConclusionThe sedative and analgesic regimen of Dexmedetomidine combined with Butorphanol tartrate can improve the gastrointestinal function of patients with acute gastrointestinal injury caused by sepsis, reduce AGI grading, reduce mechanical ventilation time and reduce the incidence of delirium.