早期目标导向镇静下不同镇静药物对谵妄发生的影响

摘要

目的 研究在早期目标导向镇静策略下,右美托咪定、咪达唑仑、丙泊酚三种药物对谵妄发生的影响.方法 选取川北医学院附属医院重症医学科需要接受镇静治疗的患者100例(2016年1月至2017年6月),随机分配接受右美托咪定(A组)、咪达唑仑(B组)、丙泊酚(C组)镇静治疗.躁动镇静评分量表评估各组镇静的水平,以达到躁动镇静评分-2～ +1分镇静目标.用重症监护病房意识模糊评估法评估患者是否发生谵妄及持续时间.结果 A组能维持更长时间的浅镇静水平. A组谵妄的发生率,谵妄持续时间和身体约束比例优于其他两组,三组机械通气时间、住ICU时间、ICU病死率没有统计学差异. C组的血流动力学变化差异有统计学意义.结论 在早期目标导向镇静策略下,右美托咪定能更好的预防谵妄发生,减少谵妄持续时间,维持血流动力学稳定,促进人文关怀.%Objective To research the influence of dexmedetomidine,midazolam,propofol three sedatives on delirium un-der early goal-directed sedation. Methods 100 cases of patients needing sedative treatment from January 2016 to June 2017 se-lected from Intensive Care Unit of affiliated hospital of north Sichuan medical college were randomly assigned to receive the dexme-detomidine(group A),midazolam(group B),propofol(group C)sedative therapy. Sedation-Agitation scale was used to evaluate se-dation level of each group in order to achieve the goal of-2～ +1 scores. The confusion assessment method for the Intensive Care U-nit was used to assess whether delirium occured to patients and its duration. Results Group A could maintain shallow level of sedation for longer time. The incidence of delirium,delirium duration and physical restraint proportion of group A were superior to the other two groups. There was no statistically significant difference in mechanical ventilation time,ICU stay time and ICU fatality of three groups. Hemodynamic changes of group C was statistically significant. Conclusion Right under the early goal-directed se-dation strategy,the dexmedetomidine can better prevent delirium occurring,reduce the duration of delirium,maintain hemodynam-ic stability and promote the humanistic care.