ICU机械通气患者撤机中应用右美托咪定对谵妄发生的影响
发布时间：2018-11-19 15:47
【摘要】：目的:ICU谵妄是一个容易被临床医师忽视的意识障碍性疾病,但其对于危重患者的临床预后与转归却有着至关重要的影响。然而,无论是谵妄发生的病理生理机制,还是预防及治疗皆没有明确的结论。目前,普遍认为对谵妄需要进行及时的评估和管理,尤其是对患者危险因素的评估和消除。这其中ICU患者的镇静策略和镇静药物的选择成为十分重要的一个环节。正是基于以上种种理论,对于ICU机械通气过渡拔管进行脱机训练的患者选择右美托咪定进行镇静,观察评估其对患者谵妄发生的影响,为机械通气患者的镇静选择提供一种依据。方法:选择2014年1月-2017年2月期间入住延安大学附属医院重症医学科接受机械通气,年龄在18-65周岁以及APACHEⅡ评分在10-40分并且评估可以试撤机的危重症患者共196例,随机分为2组:干预组在脱机训练期间给予右美托咪定镇静,对照组继续使用咪达唑仑或者咪达唑仑和/或丙泊酚进行镇静,观察比较两组谵妄发生率有无统计学差异。两组机械通气期间,均使用咪达唑仑或者咪达唑仑和/或丙泊酚镇静。所有镇静药物使用按照标准剂量给药。根据RASS评分评估镇静深度,随时调节药物剂量。观察的指标:机械通气天数;PH、钠离子、钾离子、肌酐、白蛋白;谵妄发生例数。结果:1.本研究纳入疾病的种类,大致分为有机磷中毒、急性胰腺炎、重度子痫前期和子痫、重症肺炎、感染性休克、多发伤以及其他疾病。前几种疾病,差异无统计学意义(P值分别为0.189、0.552、0.201、0.543、0.458、0.103)。在其他疾病一项的数据分析出现了统计学差异(P=0.0170.05)。2.两组患者一般资料比较:年龄差异无统计学意义(右美托咪定组39.1214.30岁vs.非右美托咪定组41.5813.79岁,P=0.2230.05);APACHEⅡ评分差异无统计学意义(右美托咪定组23.756.06分vs.非右美托咪定组23.686.36分,p=0.9320.05);机械通气天数差异无统计学意义[右美组9天(6~14)vs.非右美组9天(6~15),P=0.2050.05]。3.两组患者镇静药物使用情况分析,两组机械通气期间使用咪达唑仑或者咪达唑仑和/或丙泊酚,差异无统计学意义(P=0.0630.05)。4.两组患者生化检查指标的比较:高钾血症项(P=0.971)和低钾血症项(P=0.432);高钠血症项(P=0.421)和低钠血症项(P=0.431);肌酐(P=0.441);低蛋白血症项(P=0.570);代谢性酸中毒项(P=0.140)和代谢性碱中毒项(P=0.955),差异均无统计学意义(P值均0.05)。5.两组谵妄发生的比较:谵妄发生右美托咪定组5例,谵妄发生率占组内5.2%;非右美托咪定组15例,谵妄发生率占组内15.2%;比较两组谵妄发生率,差异有统计学意义(P=0.0210.05)。结论:与其他镇静药物相比较,ICU机械通气患者撤机期间应用右美托咪定镇静可以减少谵妄的发生。
[Abstract]:Objective: delirium ICU is a disorder of consciousness easily neglected by clinicians, but it plays an important role in the prognosis and outcome of critical patients. However, there is no clear conclusion on the pathophysiological mechanism, prevention and treatment of delirium. At present, it is widely accepted that delirium needs to be evaluated and managed in a timely manner, especially in the assessment and elimination of patient risk factors. Among them, sedation strategy and sedation drug selection for ICU patients are very important. It was based on the above theories that the patients undergoing off-line training in ICU mechanical ventilation were treated with dexmetomidine for sedation and their effects on the occurrence of delirium were observed and evaluated. To provide a basis for sedation selection of mechanical ventilation patients. Methods: from January 2014 to February 2017, 196 critically ill patients who were admitted to the Department of intensive Medicine, affiliated Hospital of Yan'an University, aged from 18 to 65 years old and with APACHE 鈪，
本文编号：2342796
[Abstract]:Objective: delirium ICU is a disorder of consciousness easily neglected by clinicians, but it plays an important role in the prognosis and outcome of critical patients. However, there is no clear conclusion on the pathophysiological mechanism, prevention and treatment of delirium. At present, it is widely accepted that delirium needs to be evaluated and managed in a timely manner, especially in the assessment and elimination of patient risk factors. Among them, sedation strategy and sedation drug selection for ICU patients are very important. It was based on the above theories that the patients undergoing off-line training in ICU mechanical ventilation were treated with dexmetomidine for sedation and their effects on the occurrence of delirium were observed and evaluated. To provide a basis for sedation selection of mechanical ventilation patients. Methods: from January 2014 to February 2017, 196 critically ill patients who were admitted to the Department of intensive Medicine, affiliated Hospital of Yan'an University, aged from 18 to 65 years old and with APACHE 鈪，
本文编号：2342796
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