咪唑安定序贯盐酸右美托咪定对ICU机械通气患者镇静的临床研究

摘要

目的 研究咪唑安定序贯盐酸右美托咪定用于重症加强护理病房(ICU)机械通气患者镇静的临床效果.方法 将河北医科大学第四医院150例ICU机械通气患者抽签随机分为A～C3组,每组50例.A组:咪唑安定+盐酸右美托咪定疗程序贯镇静,B组:咪唑安定+盐酸右美托咪定每日序贯镇静,C组单纯咪唑安定镇静,3组均配合舒芬太尼基础镇痛,以Riker镇静和躁动评分系统(SAS)指导镇静深度,以危重症疼痛观察工具(CPOT)监测镇痛效果,比较3组恢复性指标差异及舒芬太尼用量,观察3组镇静、唤醒过程中不良事件(低血压、心动过缓、谵妄)发生率及临床转归(ICU死亡、院内死亡).结果 3组机械通气时间与每日唤醒时间呈A＜B＜C的递增趋势,两两比较差异有统计学意义(P＜0.05),A、B两组ICU停留时间、住院时间、舒芬太尼用量及ICU花费组间比较差异无统计学意义(P＞0.05),但A、B两组均低于C组;3组镇静、唤醒过程低血压、心动过缓、谵妄发生率比较差异无统计学意义(P＞0.05),C组低血压、谵妄发生率稍高于A、B组,B组谵妄稍高于A组;3组ICU死亡及院内死亡发生率比较差异无统计学意义(P＞0.05).结论 咪唑安定序贯盐酸右美托咪定用于ICU机械通气患者可缩短机械通气时间,降低ICU总花费,缩短每日唤醒时间,并可降低镇痛药用量,未见明显严重不良反应发生,其中疗程序贯镇静方式具有更高的安全性.%Objective To study the clinical effect of Midazolam sequential Dexmedetomidine hydrochloride on sedation of patients undergoing mechanical ventilation in ICU.Methods One hundred and fifty cases undergoing mechanical ventilation in the ICU of our hospital were randomized into group A,group B and group C with 50 cases in each group.The group A was given Midazolam combined with Dexmedetomidine hydrochloride course-sequential sedation,while the group B was given Midazolam combined with Dexmedetomidine hydrochloride daily-sequential sedation and the group C was given simple Midazolam sedation.All groups were given Sufentanil for basic analgesia.The Riker Sedation-Agitation Scale (SAS) was used to guide the depth of sedation,and the Critical Care Pain Observation Tool (CPOT) was used to monitor the analgesic effect.The recovery indexes and the dosage of Sufentanil were compared among the three groups.The incidence rates of adverse events (hypotension,bradycardia,delirium) during sedation and awakening and clinical outcomes (ICU death and hospital death) were observed in the three groups.Results The duration of mechanical ventilation time and daily wake-up time showed an increasing trend from the group A to the group B,then to the group C,and there were significant differences between any two groups (P ＜ 0.05).There was no significant difference in the length of ICU stay,hospitalization time,dosage of Sufentanil or ICU cost between the group A and the group B (P ＞ 0.05),but the above indexes in the group A and the group B were shorter or lower than those in the group C.There were no significant differences in the incidence rates of hypotension,bradycardia or delirium during sedation and awakening among the three groups (P ＞ 0.05).The incidence rates of hypotension and delirium in the group C were slightly higher than those in the group A and the group B,and the incidence of delirium in the group B was slightly higher than that in the group A.There were no significant differences in the incidence rates of ICU death or hospital death among the three groups (P ＞ 0.05).Conclusions The application of Midazolam sequential Dexmedetomidine hydrochloride to patients undergoing mechanical ventilation in ICU can shorten the duration of mechanical ventilation,reduce the total ICU cost,shorten daily wake-up time and reduce the dosage of analgesics without serious adverse reactions.The course-sequential sedation is relatively safer.