右美托咪定联合枸橼酸舒芬太尼对重症肺炎呼吸衰竭需要机械通气患者预后的影响

摘要

目的:探讨右美托咪定联合枸橼酸舒芬太尼对重症肺炎呼吸衰竭需要机械通气患者预后的影响.方法:选取2014年7月-2016年6月本院收治的重症肺炎合并呼吸衰竭拟行机械通气治疗患者70例, 按信封法分为联合组 (n=35) 和对照组 (n=35) .对照组行机械通气+右美托咪定治疗, 联合组行机械通气+右美托咪定+枸橼酸舒芬太尼治疗.比较两组Ramsay镇静评分、VAS评分、血流动力学指标、肺功能指标、血清应激反应指标水平、不良反应发生率和住院期间死亡率等.结果:与用药前比较, 两组用药24 h和拔管后的SpO2、OI、PaO2均较高, 同期VAS评分、HR、MAP、PaCO2及血清IL-6、TNF-α和MDA水平则均降低 (P＜0.05) .与对照组比较, 联合组用药24 h和拔管后的Ramsay镇静评分为2～3分患者比例、OI和PaO2均较高, 同期VAS评分、PaCO2及血清IL-6、TNF-α和MDA水平则均降低 (P＜0.05) .联合组住院期间存活率高于对照组 (P＜0.05) .两组不良反应发生率比较, 差异无统计学意义 (P＞0.05) .结论:右美托咪定联合枸橼酸舒芬太尼应用于重症肺炎呼吸衰竭需要机械通气患者的镇静镇痛效果和预后较佳, 可行性和安全性良好.%Objective:To investigate the effects of Dexmedetomidine combined with Citrate Sufentanil on the prognosis of patients with severe pneumonia and respiratory failure requiring mechanical ventilation. Method:From July 2014 to June 2016, 70 patients with severe pneumonia complicated with respiratory failure who were treated with mechanical ventilation were selected, they were divided into the combined group (n=35) and the control group (n=35) according to the envelope method.The control group underwent mechanical ventilation+Dexmedetomidine treatment, the combined group had mechanical ventilation+Dexmedetomidine+Citra te Sufentanil treatment.Ramsay sedation score, VAS score, hemodynamics indexes, pulmonary function indexes and stress reaction indexes, adverse reaction rate and hospital mortality of two groups were measured and compared.Result:Compared with before treatment, SpO2, OI and PaO2 were higher in both groups 24 h after treatment and after extubation, while VAS score, HR, MAP, PaCO2 and serum IL-6, TNF-α and MDA levels were decreased in the same period (P＜0.05).Compared with the control group, patients in the combined group 24 h after treatment and after extubation, the Ramsay sedative score of 2-3 points, OI and PaO2 all more higher, while the VAS score, PaCO2 and serum IL-6, TNF-αand MDA all decreased during the same period (P＜0.05).Survival rate during hospitalization of the combined group was higher than that of the control group (P＜0.05).Adverse reactions rate of the combined group and control group had no significant difference (P＞0.05).Conclusion:Dexmedetomidine combined with Citrate Sufentanil used in patients with severe pneumonia and respiratory failure requiring mechanical ventilation can gain good sedative and analgesic effect and prognosis, it had good feasibility and safety.