作　　者： (王洪州）; (邓丽娟）; (程森中）; (汤秦）;

机构地区： 四川绵阳四0四医院重症医学科,四川绵阳621000

出　　处： 《临床急诊杂志》 2017年第8期579-582,共4页

摘　　要： 目的:研究右美托咪定联合脑电双频谱指数(BIS)用于慢性阻塞性肺疾病急性加重(AECOPD)机械通气患者早期目标导向镇静的效果。方法:将70例AECOPD机械通气患者随机分为右美托咪定组和咪达唑仑组,每组35例,镇静目标BIS监测70~80,首剂负荷及维持剂量均按照说明书进行。比较2组患者带机时间、血压减低、呼吸抑制、谵妄发生、唤醒时间、ICU住院时间方面的指标。结果:2组达到镇静目标所需时间差异无统计学意义。唤醒时间方面,右美托咪定组与咪达唑仑组比较差异有统计学意义(P<0.05),前者更容易唤醒。右美托咪定组ICU住院时间(7.3±0.9)d、机械通气时间(3.2±0.8)d均短于咪达唑仑组(8.5±1.2)d、(5.6±1.8)d,差异有统计学意义(P<0.05)。呼吸抑制和谵妄发生率(5.7%和5.7%)低于咪达唑仑组(34.2%和11.4%),差异有统计学意义(P<0.05)。右美托咪定组血压减低发生率(14.3%)低于咪达唑仑组(60.0%),差异有统计学意义(P<0.05)。结论:右美托咪定联合BIS用于AECOPD机械通气患者施行早期目标导向镇静是可行的,镇静效果满意,可缩短ICU住院及机械通气时间,呼吸循环影响较小,谵妄发生较少。 Objective：To study the dexmedetomidineand BIS in early goal-directed sedation during mechanical ventilation in patients with AECOPD.Method：Seventy patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）under mechanical ventilation were randomly divided into two groups（dexmedetomidine and midazolam group）,Each group included 35 patients with BIS 70~80in target controlled infusion of dexmedetomidine and midazolam,respectively.The blood pressure,reduce machine time,respiratory depression,delirium,wake-up time,and ICU stay time in terms of indicators were compared between two groups.Result：There were no significant difference in the time needed to achieve calm target between two groups.However,the patients in dexmedetomidine group were much easier to wake up than those in midazolam group（P〈0.05）.The ICU length of stay and duration of mechanical ventilation（7.3±0.9）d and（3.2±0.8）d in dexmedetomidine group were shorter than those in midazolam group（8.5±1.2）d and（5.6 ±1.8）d,P〈0.05,and incidence of the respiratory depression and delirium 5.7% and 5.7%）in dexmedetomidine group was lower than that in midazolam group（34.2% and 11.4%）（P〈0.05）.The incidence of blood pressure reduction in dexmedetomidine group（14.3%）is lower than that in midazolam group（60.0%）（P〈0.05）.Conclusion：The application of dexmedetomidine and BIS in early goal-directed sedation during mechanical ventilation in patients with AECOPD is feasible,which can shorten the hospitalization in ICU and mechanical ventilation time,reduce the intervention on the respiration and circulation,and decrease the occurrence of delirium.

关 键 词： 脑电双频谱指数 右美托咪定 慢性阻塞性疾病急性加重 镇静