右美托咪定在慢性阻塞性肺疾病急性发作患者机械通气镇静中的疗效分析

目的：评估右美托味定在慢性阻塞性肺疾病急性发作（AECOPD）患者机械通气镇静中的疗效及安全性。方法：选择60例AECOPD并发呼吸衰竭在ICU接受有创机械通气的患者，按随机数字表法分成右美托咪定组30例和咪达唑仑组30例，观察两组患者镇静的成功率、机械通气时间、ICU住院时间、谵妄发生率、呼吸机相关性肺炎（VAP）的发生率以及心血管不良事件的发生率。结果：两组患者均能达到良好的镇静效果（93．33％：96．67％，P〉0．05），但右美托咪定组所需吗啡用量明显少于咪达唑仑组（1．2±0．3）mg／h：（2．5±0．4）mg／h，P〈0．05]；右美托咪定组机械通气时间、谵妄发生率、呼吸机相关性肺炎（VAP）的发生率、ICU住院时间均少于咪达唑仑组（5．22±2．36）d、10％、16．67％、（4．25±1．25）d：（5．63±2．86）d、（2．58±1．36）h、42％、34％、（6．33±2．74）d，P〈0．osJ；右美托咪定组心动过缓发生率较咪达唑仑组高（12％：4%，P〈0．05），低血压发生率两者相似（22％：20％，P〉0．05）。结论：右美托咪定在起到较好理想镇静效果的同时，所需吗啡应用剂量小，并可以减少机械通气时间、ICU住院时间，减少谵妄发生率，减少呼吸机相关性肺炎发生。其临床不良反应发生率低，安全性较高，可作为AECOPD行机械通气患者镇静的一线用药。

Sedtive effects of dexmedetomidine on patients of AECOPD with mechanical ventilation of in intensive care unit

Objective：To investigagte the effect and security of dexmedetomidine in sedation on AECOPD pa tients in intensive care unit. Method： 60 AECOPD patients who accepted invasive mechanical ventilation in ICU were randomly divided into dexmedetomidine group （n= 30） and midazolam group （n = 30）. Observe the percent age of successful sedation, the length time of mechanical ventilation, the length time of ICU, the incidence of deliri- um, VAP, adverse cardiovascular events. Result：The percentage of successful sedatiion was similar in dexmedeto- midine group and midazolam group （93.33% vs 96.67G ,P〈0.05）. The dose of morphine of dexmedetomidine group was smaller less than that of midazolam group （1.2±0.3 mg/h vs 2.5i0.4 mg/h,PM〈0.05）. The length time of mechanical ventilation,the length time of ICU of dexmedetomidine group were shorter than that of midazo- lam group（5.22±2.36 d,4. 25±1. 25 d vs 5.63±2.86 d,6. 33±2. 74 d,P〈0.05）. The incidence of delirium and VAP of dexmedetomidine group was lower than that of midazolam group（10%,16.67% vs 42%,34% ,P〈0.05）. There was no significant difference in the incidence of hypotension between two groups （22% vs 20% ,P〈0.05）. The incidence of bradycardia in dexmedetomidine group was higher than that in midazolam group （12% vs 4% ,P 〈0.05）. Conclusion： Dexmedetomidine could make AECOPD patients achieve the target sedtion and reduse the dose of morphine,while shorting the length of mechanical ventilation, the length of ICU. And it could reduce the in cidence of delirium and VAP. The overall incidence of adverse reactions was low. It could be the recommended drug for sedation of AECOPD patients in ICU.