右美托咪定对老年术后机械通气患者睡眠与认知功能的影响
发布时间：2019-03-02 16:01
【摘要】：目的:评估右美托咪定对ICU老年术后机械通气患者睡眠、认知功能的影响。比较右美托咪定与咪达唑仑对择期老年术后机械通气患者浅镇静治疗短期及长期睡眠质量和认知功能影响的差异。方法:将重症监护室腹腔肿瘤行下腹部手术的老年术后机械通气患者60例,随机分为右美托咪定组(Dex组)咪达唑仑组(Mi组)各30例。每位患者常规给予芬太尼持续泵入镇痛,Dex组以负荷剂量1.0μg/kg/h泵入右美托咪定10分钟,继以0.2~1.0 ug/kg/h速率持续泵入。Mi组以0.02~0.10 mg/kg/h速率持续泵入咪达唑仑。两组均维持Richmond躁动-镇静评分(RASS)㧟2~0分,同期行BIS监测镇静深度、维持BIS值在65~85浅镇静状态。以PSG多导睡眠检测仪记录患者术后转入ICU第一夜22:00点至次日6:00点期间睡眠脑电图,并记录两组患者ICU期间不良事件(意外脱管事件,心血管事件,呼吸抑制事件)发生次数。以ICU意识模糊评估法(CAM-ICU)评估两组患者术后7天内谵妄的发生例数。比较两组患者机械通气及拔管时间,ICU留住时间,术后总住院时间。分别于术前一天(T-1)、术后第1天(T-2)、术后第3天(T-3)、术后第7天(T-4)及术后第14天(T-5)评估简易精神状态评价量表(MMSE)。以匹兹堡睡眠质量指数(PSQI)和MMSE量表随访患者90天睡眠质量及认知功能状态。结果:1.Dex组睡眠效率、深度睡眠N3期占比(N3%TST)、快速动眼睡眠占比(REM%TST)均明显高于Mi组(t=0.04~3.44,P0.05),N1期睡眠占比(N1%TST)、非快速动眼期睡眠占比(NREM%)、觉醒指数(次/h)均明显低于Mi组(t=㧟2.83~㧟3.73,P0.05),两组比较N2期睡眠占比(N2%TST)无明显差异(P0.05)。2.术后7天内谵妄发生率比较(Dex组13.3%VS Mi组36.7%),Dex组较Mi组患者显著减少(?2=4.283,P0.05),两组术后7天内总的谵妄发生率为25%。3.两组患者留住ICU期间不良事件发生率无明显差异(P0.05)。4.Dex组机械通气时间、拔管时间、留住ICU时间均明显少于Mi组患者(t=-0.63~-1.81,P0.05),但两组患者术后住院总时间无明显差异(P0.05)。5.两种镇静药物及5个时间点间认知功能MMSE评分有显著差异(F=7.41、180.79,P0.05)。Mi组较Dex组T2时MMSE评分降低显著(t=2.63,P0.05),T3、T4时恢复缓慢(t=4.21、3.77,P0.05)。DEX组患者术后第7天MMSE评分已升高至术前水平(P0.05),Mi组至术后第14天认知功能评分才恢复至术前水平(P0.05)。Dex组术后T2、T3、T4时间点MMSE评分均明显高于Mi组(t=2.63~4.21,P0.05),T5时两组MMSE评分无明显差异(P0.05)。6.两组术后认知功能下降例数及比例比较,Dex组较Mi组T2、T4时明显减少(?2=㧟4.28、㧟7.80,P0.05),T3、T5时两组无明显差异(P0.05)。7.两组患者术后90天MMSE评分及PSQI无明显差异(P0.05)。结论:1.老年术后ICU机械通气患者给予右美托咪定或咪达唑仑浅镇静治疗,右美托咪定较咪达唑仑镇静诱导睡眠效率高,觉醒减少,快速动眼睡眠(REM期)、深度睡眠(N3期)较咪达唑仑比例高。2.右美托咪定较咪达唑仑降低术后老年患者谵妄发生率。降低机械通气时间、拔管时间、留住ICU时间,但并不降低术后总住院天数。3.老年择期术后短期机械通气患者镇静右美托咪定为较理想选择。
[Abstract]:Objective: To evaluate the effect of dexmedetomidine on the sleep and cognitive function of postoperative mechanical ventilation in the elderly. To compare the effects of dexmedetomidine and prochloronil on the short-term and long-term sleep quality and cognitive function of patients with mechanical ventilation after elective operation. Methods:60 cases of postoperative mechanical ventilation in the abdominal operation of the intensive care unit were randomly divided into 30 cases of the dexmedetomidine group (Dex group) and the Mimidamilun group (Mi group). Each patient was routinely given fentanyl for analgesia, and the Dex group was pumped into dexmedetomidine for 10 minutes at a load dose of 1.0. m u.g/ kg/ h and continuously pumped at a rate of 0.2 to 1.0 ug/ kg/ h. The Mi-group was continuously pumped at 0.02-0.10 mg/ kg/ h at the rate of 0.02-0.10 mg/ kg/ h. The Richmond restlessness-sedation score (RASS) was maintained at 2-0 points in both groups, and the sedation depth was monitored by the BIS in the same period, and the BIS value was maintained at 65-85. The patient's sleep EEG was recorded at 22:00 a.m. to 6:00 a. m. on the first night of the ICU following the operation of the PSG multi-lead sleep detector, and the number of adverse events (accidental de-tube events, cardiovascular events, respiratory depression events) in the two groups of patients was recorded. The number of cases in the two groups was evaluated by the ICU-Aware Fuzzy Assessment (CAM-ICU) for 7 days after the operation. The mechanical ventilation and the time of extubation, the retention time of the ICU and the total hospital stay were compared between the two groups. The Simple Mental State Evaluation Scale (MMSE) was evaluated on day one (T-1), post-operative Day 1 (T-2), postoperative day 3 (T-3), postoperative day 7 (T-4), and postoperative day 14 (T-5). The sleep quality and cognitive function of 90 days were followed up with the Pittsburgh Sleep Quality Index (PSQI) and the MMSE scale. Results:1. The sleep efficiency, deep sleep N3 ratio (N3% TST) and fast-moving-to-eye sleep ratio (REM% TST) in the Dex group were significantly higher than that of the Mi group (t = 0.04-3.44, P0.05), the N1-phase sleep ratio (N1% TST), the non-rapid-eye-period sleep ratio (NREM%) and the wake-up index (times/ h) were significantly lower than that of the Mi group (t =-2.83--3.73, There was no significant difference between the two groups (P0.05). In the 7-day post-operation, there was a significant reduction in the incidence of arrogance (36.7% in the Dex group, 13.3% vs. Mi, 36.7% in the Dex group), and the number of patients in the Dex group was significantly reduced (? 2 = 4.283, P0.05). There was no significant difference in the incidence of adverse events in the two groups (P0.05).4. The time of mechanical ventilation and the time of extubation in the Dex group and the time of retaining the ICU were significantly lower than those in the Mi group (t =-0.63--1.81, P0.05), but there was no significant difference between the two groups after the operation (P0.05). The MMSE scores of the two sedative drugs and the five time points were significantly different (F = 7.41, 180.79, P0.05). The MMSE score in the Mi group was lower than that of the Dex (t = 2.63, P0.05), the recovery of T3 and T4 (t = 4.21, 3.77, P0.05). The 7-day MMSE score in the DEX group was increased to the pre-operative level (P0.05). The scores of MMSE in the time points of T2, T3 and T4 were significantly higher in the group Mi than in the Mi group (t = 2.63-4.21, P0.05), and there was no significant difference between the two groups (P0.05). The number and proportion of cognitive function decreased in the two groups. 2 =? 4.28,? 7.80, P0.05), T3 and T5, there was no significant difference between the two groups (P0.05). There was no significant difference in MMSE and PSQI between the two groups after operation (P0.05). Conclusion:1. In the elderly patients with mechanical ventilation, the patients with mechanical ventilation were given dexmedetomidine or prochloronil, and the dexmedetomidine was more effective in the induction of sleep efficiency, decreased awaking, fast-moving-eye sleep (REM), deep sleep (N3), and high proportion of prochlorin. The effect of dexmedetomidine on the incidence of post-operative mortality in elderly patients. The time of mechanical ventilation, the time of extubation, the time to retain the ICU were reduced, but the total length of hospital stay was not reduced. It is an ideal choice for the elderly patients with short-term mechanical ventilation after elective operation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：2433210
[Abstract]:Objective: To evaluate the effect of dexmedetomidine on the sleep and cognitive function of postoperative mechanical ventilation in the elderly. To compare the effects of dexmedetomidine and prochloronil on the short-term and long-term sleep quality and cognitive function of patients with mechanical ventilation after elective operation. Methods:60 cases of postoperative mechanical ventilation in the abdominal operation of the intensive care unit were randomly divided into 30 cases of the dexmedetomidine group (Dex group) and the Mimidamilun group (Mi group). Each patient was routinely given fentanyl for analgesia, and the Dex group was pumped into dexmedetomidine for 10 minutes at a load dose of 1.0. m u.g/ kg/ h and continuously pumped at a rate of 0.2 to 1.0 ug/ kg/ h. The Mi-group was continuously pumped at 0.02-0.10 mg/ kg/ h at the rate of 0.02-0.10 mg/ kg/ h. The Richmond restlessness-sedation score (RASS) was maintained at 2-0 points in both groups, and the sedation depth was monitored by the BIS in the same period, and the BIS value was maintained at 65-85. The patient's sleep EEG was recorded at 22:00 a.m. to 6:00 a. m. on the first night of the ICU following the operation of the PSG multi-lead sleep detector, and the number of adverse events (accidental de-tube events, cardiovascular events, respiratory depression events) in the two groups of patients was recorded. The number of cases in the two groups was evaluated by the ICU-Aware Fuzzy Assessment (CAM-ICU) for 7 days after the operation. The mechanical ventilation and the time of extubation, the retention time of the ICU and the total hospital stay were compared between the two groups. The Simple Mental State Evaluation Scale (MMSE) was evaluated on day one (T-1), post-operative Day 1 (T-2), postoperative day 3 (T-3), postoperative day 7 (T-4), and postoperative day 14 (T-5). The sleep quality and cognitive function of 90 days were followed up with the Pittsburgh Sleep Quality Index (PSQI) and the MMSE scale. Results:1. The sleep efficiency, deep sleep N3 ratio (N3% TST) and fast-moving-to-eye sleep ratio (REM% TST) in the Dex group were significantly higher than that of the Mi group (t = 0.04-3.44, P0.05), the N1-phase sleep ratio (N1% TST), the non-rapid-eye-period sleep ratio (NREM%) and the wake-up index (times/ h) were significantly lower than that of the Mi group (t =-2.83--3.73, There was no significant difference between the two groups (P0.05). In the 7-day post-operation, there was a significant reduction in the incidence of arrogance (36.7% in the Dex group, 13.3% vs. Mi, 36.7% in the Dex group), and the number of patients in the Dex group was significantly reduced (? 2 = 4.283, P0.05). There was no significant difference in the incidence of adverse events in the two groups (P0.05).4. The time of mechanical ventilation and the time of extubation in the Dex group and the time of retaining the ICU were significantly lower than those in the Mi group (t =-0.63--1.81, P0.05), but there was no significant difference between the two groups after the operation (P0.05). The MMSE scores of the two sedative drugs and the five time points were significantly different (F = 7.41, 180.79, P0.05). The MMSE score in the Mi group was lower than that of the Dex (t = 2.63, P0.05), the recovery of T3 and T4 (t = 4.21, 3.77, P0.05). The 7-day MMSE score in the DEX group was increased to the pre-operative level (P0.05). The scores of MMSE in the time points of T2, T3 and T4 were significantly higher in the group Mi than in the Mi group (t = 2.63-4.21, P0.05), and there was no significant difference between the two groups (P0.05). The number and proportion of cognitive function decreased in the two groups. 2 =? 4.28,? 7.80, P0.05), T3 and T5, there was no significant difference between the two groups (P0.05). There was no significant difference in MMSE and PSQI between the two groups after operation (P0.05). Conclusion:1. In the elderly patients with mechanical ventilation, the patients with mechanical ventilation were given dexmedetomidine or prochloronil, and the dexmedetomidine was more effective in the induction of sleep efficiency, decreased awaking, fast-moving-eye sleep (REM), deep sleep (N3), and high proportion of prochlorin. The effect of dexmedetomidine on the incidence of post-operative mortality in elderly patients. The time of mechanical ventilation, the time of extubation, the time to retain the ICU were reduced, but the total length of hospital stay was not reduced. It is an ideal choice for the elderly patients with short-term mechanical ventilation after elective operation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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相关期刊论文 前3条
1 李建国;;以镇痛为基础的镇静[J];中华内科杂志;2013年04期
2 邱海波;;重症患者的镇痛和镇静:以疾病为导向[J];中华内科杂志;2013年04期
3 马晓春;肇冬梅;;镇痛和镇静的规范化与个体化治疗[J];中华内科杂志;2013年04期
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