模拟人体生物钟镇静在ICU机械通气谵妄防控中的研究
发布时间：2018-12-06 20:20
【摘要】：目的：根据人体正常生物钟昼夜节律的睡眠/清醒的特点,通过动态监测、控制患者镇静深度,模拟正常生物钟使患者表现为白天清醒、夜间睡眠的镇静方法,探讨模拟人体生物钟镇静与ICU机械通气患者谵妄的发生、疾病预后的相关性；为ICU机械通气患者选择合理有效的镇静方法、镇静药物及剂量,降低谵妄及其它并发症的发生率,从而改善患者的预后。方法：选取2014年7月至2015年2月入住本院ICU接受机械通气治疗时间≥12h的患者84例纳入研究,其中14例患者因严重的不良反应或不能达到满意的镇静效果而被剔除,最终70例患者纳入本研究。所有纳入研究的患者常规应用芬太尼镇痛治疗,将患者随机分为模拟生物钟组(A组)与非模拟生物钟组(B组),依据使用镇静药物的不同(右美托咪定、丙泊酚,右美托咪定+丙泊酚)进一步分为6个组,即A1、B1使用右美托咪定镇静,A2、B2使用丙泊酚镇静,A3、B3使用右美托咪定+丙泊酚联合镇静；同时应用VAS视觉模拟评分标准、RASS镇静程度评估表对镇痛镇静的深度进行量化控制,滴定式调节镇静药物的剂量,使模拟生物钟组RASS评分白天维持在0～1分,夜间维持在-1～-2分；非模拟生物钟组RASS评分昼夜维持在-1～-2分；同时采用ELISA法监测两组患者尿液6-羟基硫酸褪黑素(aMT6s)水平,总结昼夜变化节律并进行对比；比较两组患者谵妄及其它不良反应的发生率、机械通气时间、拔管时间、ICU住院时间、镇静镇痛药物剂量是否存在差异。结果：(1)6组患者性别、年龄、急性生理学与慢性健康状态评分系统Ⅱ (APACHEⅡ)评分等基础状态无明显差异(P0.05),各组之间具有可比性。(2)模拟人体生物钟组与非模拟人体生物钟对比,通过动态监测尿液中aMT6s浓度,前者尿液中6AM检测的aMT6s水平较后者有增高趋势,但无统计学意义。(3)模拟人体生物钟组与非模拟人体生物钟组对比,谵妄发生率明显降低(P0.05)；A1与B1对比,A2与B2对比,A3与B3对比,机械通气时间、拔管时间、ICU住院时间均缩短,使用镇静药物剂量减少(P0.05)。(4)镇静药物组间对比,右美托咪定可降低谵妄的发生率(P0.05)。(5)谵妄的发生与机械通气时间、拔管时间、ICU住院时间呈正相关(P0.05)。结论：(1)ICU机械通气患者谵妄的发生与患者机械通气时间、拔管时间、ICU住院时间呈正相关。(2)模拟人体生物钟镇静可减少ICU机械通气患者机械通气时间、拔管时间、ICU住院时间,减少镇静药物的使用剂量,降低谵妄发生率。(3)使用右美托咪定镇静可降低谵妄的发生率,可用于谵妄的防控治疗。
[Abstract]:Objective: according to the characteristics of the circadian rhythm of human normal body clock, the sedation depth of patients was controlled by dynamic monitoring, and the sedation method of daytime and night sleep was simulated by simulating normal biological clock. To investigate the correlation between mimic body clock sedation and the occurrence of delirium and prognosis of patients with ICU mechanical ventilation. In order to improve the prognosis of ICU patients with mechanical ventilation, rational and effective sedation methods, sedation drugs and dosage were selected to reduce the incidence of delirium and other complications. Methods: from July 2014 to February 2015, 84 patients admitted to our hospital for mechanical ventilation for more than 12 hours were enrolled in the study. 14 patients were excluded because of severe adverse reactions or failure to achieve satisfactory sedation effect. Finally, 70 patients were included in this study. All patients included in the study were treated with fentanyl analgesia and were randomly divided into two groups: simulated circadian clock group (group A) and non-simulated biological clock group (group B), depending on the use of sedative drugs (dexmetoimidine, propofol, and propofol). Dexmetomidine propofol) was further divided into 6 groups, namely, A1mb _ 1 was sedated with dexmetomidine, A _ 2 was treated with propofol, and A _ 3 was treated with dexmetidine propofol combined with sedation. At the same time, VAS visual analogue score, RASS sedative degree evaluation table were used to quantify the depth of analgesia sedation, titration was used to adjust the dose of sedative, so that the RASS score of simulated biological clock group was maintained at 0 ~ 1 points during the day. The nocturnal value was maintained at -1 and 2 minutes; The RASS score of non-simulated circadian clock group was maintained at -1 / 2, and the urine aMT6s level of the two groups was monitored by ELISA method, and the circadian rhythm was summarized and compared. The incidence of delirium and other adverse reactions, mechanical ventilation time, extubation time, ICU hospitalization time and dose of sedative and analgesic drugs were compared between the two groups. Results: (1) there were no significant differences in sex, age, acute physiology and chronic health status scoring system 鈪，
本文编号：2366603
[Abstract]:Objective: according to the characteristics of the circadian rhythm of human normal body clock, the sedation depth of patients was controlled by dynamic monitoring, and the sedation method of daytime and night sleep was simulated by simulating normal biological clock. To investigate the correlation between mimic body clock sedation and the occurrence of delirium and prognosis of patients with ICU mechanical ventilation. In order to improve the prognosis of ICU patients with mechanical ventilation, rational and effective sedation methods, sedation drugs and dosage were selected to reduce the incidence of delirium and other complications. Methods: from July 2014 to February 2015, 84 patients admitted to our hospital for mechanical ventilation for more than 12 hours were enrolled in the study. 14 patients were excluded because of severe adverse reactions or failure to achieve satisfactory sedation effect. Finally, 70 patients were included in this study. All patients included in the study were treated with fentanyl analgesia and were randomly divided into two groups: simulated circadian clock group (group A) and non-simulated biological clock group (group B), depending on the use of sedative drugs (dexmetoimidine, propofol, and propofol). Dexmetomidine propofol) was further divided into 6 groups, namely, A1mb _ 1 was sedated with dexmetomidine, A _ 2 was treated with propofol, and A _ 3 was treated with dexmetidine propofol combined with sedation. At the same time, VAS visual analogue score, RASS sedative degree evaluation table were used to quantify the depth of analgesia sedation, titration was used to adjust the dose of sedative, so that the RASS score of simulated biological clock group was maintained at 0 ~ 1 points during the day. The nocturnal value was maintained at -1 and 2 minutes; The RASS score of non-simulated circadian clock group was maintained at -1 / 2, and the urine aMT6s level of the two groups was monitored by ELISA method, and the circadian rhythm was summarized and compared. The incidence of delirium and other adverse reactions, mechanical ventilation time, extubation time, ICU hospitalization time and dose of sedative and analgesic drugs were compared between the two groups. Results: (1) there were no significant differences in sex, age, acute physiology and chronic health status scoring system 鈪，
本文编号：2366603
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