不同镇静深度对急性冠脉综合征机械通气患者心血管事件的影响

目的 比较不同镇静深度对急性冠脉综合征（ACS）并机械通气患者心血管事件的影响。方法56 例需机械辅助通气ACS 患者，随机分为浅镇静组29 例（M 组，RASS 评分0 ～ -2 分），深镇静组27 例（D 组，RASS 评分-3 ～ -4 分），所有患者使用地佐辛镇痛，使用丙泊酚+ 右美托咪定镇静，以镇静评分目标调整药物剂量。使用动态心电图进行48 h 连续监测，比较两组心律失常、急性心肌缺血、机械通气时间、ICU 住院时间、谵妄发生率及28 d 生存率。结果 两组在频发室性早搏的发生率、室性心动过速阵次、快速型室上性心律失常阵次及急性心肌缺血阵次的发生频次比较，差异有统计学意义（P <0.05），D 组均低于M 组；两组谵妄发生率、机械通气时间、ICU 住院时间及28 d 生存率比较差异无统计学意义（P >0.05）。结论 ACS 并机械通气患者，早期深镇静可以有效减少心律失常（频发室性早搏、室性心动过速、快速型室上性心律失常）及急性心肌缺血的发生率，且不增加机械通气时间和ICU 住院时间，不影响28 d 生存率。

Effect of different degree of sedation on ACS patients withmechanical ventilation

Objective To compare the effects of different degree of sedation on acute coronary syndrome(ACS) patients with mechanical ventilation. Methods Fifty-six patients with ACS who received mechanicalventilation were randomly divided into mild sedation group (group M, RASS score 0 to -2, n = 29) and deep sedationgroup (group D, RASS score-3 to -4, n = 27). Analgesia was achieved with Dezocine. Sedation was achieved withDexmedetomidine and Propofol. The dose of sedation was determined based on Richmond agitation-sedationscale. Dynamic electrocardiogram continuous monitoring for 48 h was performed. Cardiovascular events includingarrhythmia, acute myocardial ischemia, time duration of mechanical ventilation, ICU stay, delirium, and 28 dayssurvival rate were compared and analyzed. Results Incidence of arrhythmia such as frequent ventricular prematurebeat, ventricular tachycardia, supraventricular tachyarrhythmia, and acute myocardial ischemia were decreasedsignificantly in group D when compared with group M (P < 0.05) There was no significant difference in mechanicalventilation time , ICU length of hospital stay ,delirium and 28 days survival rate between two groups (P > 0.05).Conclusion In ACS patients with mechanical ventilation, early deep sedation can reduce the incidence of arrhythmia and acute myocardial ischemia without increase of mechanical ventilation time and ICU stay.