右美托咪定对无创通气AECOPD患者镇静安全性及有效性研究.docVIP

右美托咪定对无创通气AECOPD患者镇静安全性及有效性研究 　　[摘要] 目的 评估右美托咪定对慢性阻塞性肺部疾病急性发作期患者需要使用无创通气支持下镇静的安全性及有效性。 方法 选取2015年3月～2017年2月我院入住重症医学科的AECOPD并需要无创通气支持的患者64例，随机分为右美托咪定组和对照组，每组32例，两组均给予无创通气和常规治疗，右美托咪定组予右美托咪定维持量（0.2～0.7）μg/（kg?h），维持RASS评分-1～+1分，比较两组患者0 h、6 h、12 h、24 h、48 h的氧合指数、二氧化碳分压、平均动脉压、心率。并比?^两组患者的无创机械通气时间、有创通气率、ICU住院时间及谵妄的发生率及患者28 d生存率，观察右美托咪定组有无戒断症状。 结果 右美托咪定组6 h后二氧化碳明显较对照组下降（P0.05），24 h后氧合明显较对照组改善（P0.05），6 h、12 h平均动脉压较对照组下降（P0.05），心率6 h后均较对照组明显下降（P0.05），但无明显心动过缓。右美托咪定组无创通气时间、留住ICU时间较对照组明显缩短（P0.05），有创通气率及谵妄发生率降低，有显著差异（P0.05）。右美托咪定组无明显戒断症状发生，两组患者的28 d生存率无明显差异。 结论 右美托咪定联合无创机械通气支持显著改善AECOPD患者氧合，减少机械通气时间及住ICU时间，减少插管率及谵妄发生率，且安全性较高。 　　[关键词] 右美托咪定；慢性阻塞性肺病急性发作；无创通气；镇静 　　[中图分类号] R563 [文献标识码] B [文章编号] 1673-9701（2017）35-0086-03 　　[Abstract] Objective To evaluate the safety and efficacy of dexmedetomidine on sedation of acute exacerbation of chronic obstructive pulmonary disease patients requiring noninvasive ventilation. Methods A total of 64 acute exacerbation of chronic obstructive pulmonary disease patients requiring noninvasive ventilation who were admitted in the Department of Intensive Care Unit in our hospital from March 2015 to February 2017 were randomly divided into dexmedetomidine group and control group，with 32 cases in each group. The patients in two groups were given noninvasive ventilation and conventional treatment. The dexmedetomidine group was given the dexmedetomidine with the maintenance dose of （0.2-0.7）μg/（kg?h）， maintaining RASS score -1-+1 points. The oxygenation index， carbon dioxide partial pressure， mean arterial pressure and heart rate were compared between the two groups at 0 h， 6 h， 12 h， 24 h and 48 h. And the noninvasive mechanical ventilation time， invasive ventilation rate， ICU hospitalization time and the incidence of delirium and 28-day survival rate of patients between the two groups were compared. And it was observed that whether there were withdrawal symptoms of the dexmedetomidine group. Results The carbon dioxide in the dexmedetomidine group was