模拟人体生物钟镇静对 ICU 机械通气病人谵妄发生的影响

摘要

目的：探讨模拟人体生物钟镇静对 ICU 机械通气病人谵妄发生的影响。方法选择 ICU 机械通气的病人36例，随机分为模拟生物钟组与非模拟生物钟组，均采用右美托咪定镇静，其中模拟生物钟组模拟人体的正常生物钟，于白天维持 RASS 评分0~1分，夜间维持-1~-2分；非模拟生物钟组则于白天与夜间均保持 RASS -1~-2分。观察所有纳入对象不同时间点血褪黑素水平变化。对比观察两组病人机械通气时间、拔管时间、ICU 住院时间、右美托咪定的用量以及谵妄发生的情况。结果在模拟生物钟组中凌晨2点病人血清褪黑素水平显著高于同组其他时间点。在非模拟生物钟组中，病人10点和18点出现两次分泌高峰，显著高于同组其他时间点（ P ＜0.05），且高于模拟生物钟组10点与18点的分泌水平（ P ＜0.05）。模拟生物钟组机械通气时间、拔管时间、ICU 住院时间、右美托咪定累计用量均显著低于非模拟生物钟组（ P ＜0.05）。模拟生物钟组发生谵妄的比率（11.11%）显著低于非模拟生物钟组（38.98%）（ P ＜0.05）。结论右美托咪定模拟人体生物钟镇静可降低 ICU 机械通气病人谵妄的发生率，缩短机械通气时间、拔管时间和 ICU 住院时间，减少镇静药物使用剂量，值得临床参考应用。%Objective To explore the effect of simulated biological circadian clock on the occurrence of delirium in patients with mechani-cal ventilation in ICU. Methods Thirty - six patients with mechanical ventilation were randomly divided into simulated and non - simulated bio-logical clock groups according to the different treatment regimens. All patients in simulated biological clock group were sedated with dexmedetomi-dine. During the daytme,the RASS scores were maintained at 0 to 1 and they were maintained at - 1 to - 2 at the night,while the non - simula-ted circadian clock was maintained at RASS - 1 to - 2 points during the day and night. The changes of blood level of melatonin were observed at all time points. The duration of mechanical ventilation,extubation time,length of stay in ICU,dosage of dexmedetomidine and the occurrence of delirium were observed. Results The serum level of melatonin was significantly higher at 2:00 am in the simulated biological clock group than that in other time - points(P < 0. 05). In the non - simulated biological clock group,there were two peaks at 10 and 18 oˊclock( P < 0. 05), and they were higher than those of control group(10:00 and 18:00). The duration of mechanical ventilation,extubation time,length of stay in ICU,and cumulative dosages of dexmedetomidine were significantly lower in simulated biological clock group than those in non - simulated biologi-cal clock group( P < 0. 05). The occurrence of delirium in simulated biological clock group was significantly lower than that of non - simulated biological clock group( P < 0. 05). Conclusion Dexmedetomidine can reduce the incidence of delirium in patients with mechanical ventilation in ICU with small dosage of sedative drug,shorten the duration of mechanical ventilation,extubation time and length of stay in ICU,and it is wor-thy to be clinically applied.