[1]邱晓莉,文 丹.右美托咪定复合丙泊酚在呼吸窘迫综合征机械通气患者镇痛镇静中的临床应用研究[J].陕西医学杂志,2023,52(10):1399-1403.[doi:DOI:10.3969/j.issn.1000-7377.2023.10.026]
　QIU Xiaoli,WEN Dan.Application of dexmedetomidine combined with propofol in analgesia and sedation of patients with ARDS undergoing mechanical ventilation[J].,2023,52(10):1399-1403.[doi:DOI:10.3969/j.issn.1000-7377.2023.10.026]
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右美托咪定复合丙泊酚在呼吸窘迫综合征机械通气患者镇痛镇静中的临床应用研究
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年10期
页码:
1399-1403
栏目:
药物与临床
出版日期:
2023-10-05

文章信息/Info

Title:
Application of dexmedetomidine combined with propofol in analgesia and sedation of patients with ARDS undergoing mechanical ventilation
作者:
邱晓莉; 文 丹
(电子科技大学医学院附属绵阳医院 绵阳市中心医院重症医学科,四川 绵阳 621000)
Author(s):
QIU Xiaoli; WEN Dan
(Department of Critical Care Medicine,Mianyang Hospital,School of Medicine,University of Electronic Science and Technology,Mianyang 621000,China)
关键词:
右美托咪定;  丙泊酚;  机械通气;  呼吸窘迫综合征;  炎症反应
Keywords:
Dexmedetomidine;  Propofol;  Mechanical ventilation;  Respiratory distress syndrome;  Inflammatory response
分类号:
R 563
DOI:
DOI:10.3969/j.issn.1000-7377.2023.10.026
文献标志码:
A
摘要:
目的:探讨右美托咪定复合丙泊酚在呼吸窘迫综合征(ARDS)机械通气患者镇痛镇静中的应用效果。方法:选取96例ARDS机械通气患者,采用随机数字表法分为丙泊酚组(Pro组)、右美托咪定组(Dex组)组及联合组各32例,三组麻醉诱导插管后进行微量泵持续注入镇静药物治疗,Pro组先给予丙泊酚镇静诱导,Dex组右美托咪定镇静诱导,联合组给予右美托咪定复合丙泊酚镇静诱导。记录三组气管插管前0.5 h(T0)、插管后0.5 h(T1)、插管后6 h(T2)、插管后12 h(T3)、插管后24 h(T4)的血流动力学指标变化[平均动脉压(MAP)、心率(HR)],比较三组机械通气不同时间点的促炎因子水平[白细胞介素-6(IL-6)、C-反应蛋白(CRP)],记录三组机械通气1、3、7 d后的镇痛药物使用剂量和日平均用量和治疗期间的不良反应。结果:T0～T4时刻,三组MAP、HR值先下降后上升,三组时间点效应、组间效应和时间点与组间交互效应比较差异有统计学意义(均P<0.05),在T1～T2时刻,三组均显著低于T0时刻(均P<0.05),联合组和Dex组的MAP值显著高于Pro组(均P<0.05),联合组和Dex组的HR值均显著低于Pro组(均P<0.05),但联合组显著高于Dex组(P<0.05); 在机械通气1、3 d后,三组血清IL-6及CRP水平呈逐渐升高,三组时间点效应、组间效应和时间点与组间交互效应比较差异有统计学意义(均P<0.05),三组上述指标显著高于气管插管前(均P<0.05),但联合组和Dex组显著低于Pro组(均P<0.05),且联合组血清IL-6及CRP水平显著低于Dex组(均P<0.05); 在机械通气1、3、7 d后,三组镇痛药物剂量先增加后减少,三组时间点效应、组间效应和时间点与组间交互效应比较差异有统计学意义(均P<0.05),其中联合组机械通气1、3、7 d后的镇痛药物使用剂量和日平均用量显著少于Pro组和Dex组(均P<0.05); 三组间不良反应总发生率比较差异具有统计学意义(均P<0.05),其中联合组的不良反应总发生率显著低于Pro组和Dex组(均P<0.05)。结论:右美托咪定复合丙泊酚应用于ARDS机械通气患者的镇静效果优于上述两种单独使用,能有效改善机体炎症反应,并能减少不良反应,应用安全、有效。
Abstract:
Objective:To explore the application effects of dexmedetomidine combined with propofol in analgesia and sedation of patients with acute respiratory distress syndrome(ARDS)undergoing mechanical ventilation.Methods:A total of 96 patients with ARDS undergoing mechanical ventilation were selected and divided into propofol group(Pro group),dexmedetomidine group(Dex group)and combined group by the random number table method,with 32 cases in each group.After anesthesia induction intubation,the three groups received continuous injection of sedative drugs by micropump.The Pro group was first given propofol sedation induction,the Dex group was given dexmedetomidine sedation induction,and the combined group was given dexmedetomidine combined with propofol sedation induction.Hemodynamic indicators(mean arterial pressure [MAP],heart rate [HR])at 0.5 hour before tracheal intubation(T0),at 0.5 hour after intubation(T1),at 6 hour after intubation(T2),at 12 hour after intubation(T3)and at 24 hour after intubation(T4)were recorded in the three groups.The proinflammatory factors(interleukin-6 [IL-6],C-reactive protein [CRP])were compared among the three groups at different time points of mechanical ventilation,and the dosage and average daily dosage of analgesic drug after 1,3 and 7 days of mechanical ventilation and adverse reactions during treatment were recorded in the three groups.Results:During the time period from T0 to T4,the MAP and HR in the three groups were first decreased and then increased,and there were statistically significant differences in the two indicators from the aspects of time-point effect,between-group effect and interaction effect of time-point and between-group among the three groups(all P<0.05),and the indicators from T1 to T2 in the three groups were significantly lower than those at T0(all P<0.05).MAP in combined group and Dex group was significantly higher than that in Pro group(all P<0.05)while HR was significantly lower than that in Pro group(P<0.05),but the indicators in combined group were significantly higher than those in Dex group(all P<0.016).After 1,3 days of mechanical ventilation,serum IL-6 and CRP levels in the three groups were gradually increased,and there were statistically significant differences in the time-point effect,between-group effect and interaction effect of time-point and between-group(all P<0.05),and the above levels in the three groups were significantly higher than those before tracheal intubation(all P<0.05),but the levels in combined group and Dex group were significantly lower than those in Pro group(all P<0.05),and the levels of IL-6 and CRP in combined group were significantly lower than those in Dex group(all P<0.05).After 1,3 and 7 days of mechanical ventilation,the dosage of analgesic drug in the three groups was increased first and then decreased,and the differences in time-point effect,between-group effect and interaction effect of time-point and between-group among the three groups were statistically significant(all P<0.05).The dosage and average daily dosage of analgesic drug in combined group were significantly less than those in Pro group and Dex group after 1,3 and 7 days of mechanical ventilation(all P<0.05).There was a significant difference in the total incidence rate of adverse reactions among the three groups(P<0.05),and the total incidence rate of adverse reactions was significantly lower in combined group than that in Pro group and Dex group(P<0.05).Conclusion:The sedative effect of dexmedetomidine combined with propofol in patients with ARDS undergoing mechanical ventilation is better than the above two indicators alone,and it can effectively improve the body' s inflammatory response,and reduce the adverse reactions,so the application is safe and effective.

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备注/Memo

备注/Memo:
基金项目:四川省基层卫生事业发展研究中心项目(SWFZ22-C-96)
更新日期/Last Update: 2023-10-07