舒芬太尼联合右美托咪定对AECOPD机械通气患者ICU获得性衰弱的影响

摘要

OBJECTIVE:To investigate the effects of sufentanil combined with dexmedetomidine on ICU acquired weakness(ICU-AW)of AECOPD patients receiving mechanical ventilation. METHODS:A total of 120 AECOPD patients in ICU of our hospital during Oct. 2015-Oct. 2016 were divided into group A and B according to random number tablet,with 60 cases in each group. Group A was given analgesia and sedation of sufentanil combined with propofol;group B was given analgesia and sedation of sufentanil combined with dexmedetomidine. RAAS sedation score and British Medical Research Committee(MRC)score were compared between 2 groups before treatment and 7 d after treatment. The incidence of ICU-AW,delirium and tracheal extubation were observed. The staying time in ICU,total hospitalization time and the occurrence of ADR were compared between 2 groups after diagnosed as ICU-AW. RESULTS:After treatment,the scores of RASS sedation degree scale in 2 groups were decreased significantly compared to before treatment,with statistical significance (P0.05). MRC score of group A was decreased significantly compared to before treatment,and significantly lower than group B,with statistical significance(P0.05). After 7 d of treatment,the incidence of ICU-AW in group B was significantly lower than group A(40.00% vs. 56.67%);the incidence of tracheal extubation in group B was significantly higher than group A(70.00% vs. 53.33%),the incidence of delirium was significantly lower than group A(13.33% vs. 20.00%);the staying time in ICU and total hospitalization time in group B after diagnosed as ICU-AW were significantly shorter than group A,with statistical significance(P0.05). CONCLUSIONS:Compared with sufentanil combined with propofol, sufentanil combined with dexmedetomide shows similar analgesia and sedation effect,but has better influence on the muscle strength of the patient,reducing the incidence of ICU-AW and delirium,shortening the duration of mechanical ventilation,staying time in ICU and total hospitalization time in AECOPD patients receiving mechanical ventilation,with similar safety.%目的:探讨舒芬太尼联合右美托咪定对慢性阻塞性肺疾病急性发作(AECOPD)机械通气患者重症医学科(ICU)获得性衰弱(ICU-AW)的影响.方法:选择2015年10月-2016年10月我院ICU收治的120例AECOPD患者,按随机数字表法分为A、B组,每组60例.A组患者给予舒芬太尼联合丙泊酚镇痛镇静,B组患者给予舒芬太尼联合右美托咪定镇痛镇静.观察两组患者治疗前后Richmond躁动-镇静程度评估量表(RAAS镇静程度评估量表)评分和英国医学研究委员会(MRC)量表评分,治疗7 d后ICU-AW发生率、气管拔管率和谵妄发生率,并记录两组患者被诊断为ICU-AW后滞留ICU的时间、总住院时间及不良反应发生情况.结果:治疗后,两组患者RASS镇静程度评估量表评分均较治疗前显著降低,差异有统计学意义(P0.05);A组患者MRC量表评分较治疗前显著降低,且显著低于B组,差异均有统计学意义(P0.05).治疗7 d后,B组患者ICU-AW的发生率显著低于A组(40.00%vs.56.67%);B组患者的气管拔管率显著高于A组(70.00%vs.53.33%),谵妄发生率显著低于A组(13.33%vs.20.00%);B组患者被诊断为ICU-AW后滞留ICU的时间及总住院时间均显著短于A组,差异均有统计学意义(P0.05).结论:舒芬太尼联合右美托咪定对AECOPD机械通气患者的镇痛镇静效果与舒芬太尼联合丙泊酚相当,但在对患者的肌力影响,降低患者ICU-AW和谵妄的发生率,缩短患者机械通气时间、滞留ICU的时间和总住院时间方面,舒芬太尼联合右美托咪定效果更优,且安全性相当.