引用本文:乔 莉,袁宏勋,赵慧颖,王 征,安友仲.右美托咪定和丙泊酚应用于择期术后患者短期机械通气镇静治疗的效果比较[J].中国临床新医学,2024,17(6):683-689.
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右美托咪定和丙泊酚应用于择期术后患者短期机械通气镇静治疗的效果比较
乔 莉1,2,袁宏勋2,赵慧颖1,王 征2,安友仲1
1.北京大学人民医院重症医学科,北京100044;2.北京大学国际医院重症医学科,北京 102206
摘要:
[摘要] 目的 比较右美托咪定和丙泊酚应用于择期术后患者短期机械通气镇静治疗的效果。方法 招募2022年4月1日至2023年11月30日于北京大学国际医院经全麻术后带气管插管返回重症监护室(ICU)的患者97例,均行短期(<24 h)气管插管机械通气,持续镇静、镇痛。采用随机数字表法将其分为观察组(49例,予右美托咪定干预)和对照组(48例,予丙泊酚干预)。记录两组ICU观察期间降压药物(盐酸尼卡地平)使用情况。比较两组及降血压药物使用亚组镇静治疗开始前(T0)、镇静后1 h(T1)、拔除气管插管后2 h(T2)的生命体征指标[心率(HR)、呼吸频率(RR)、平均动脉血压(MAP)]、血浆儿茶酚胺[肾上腺素(E)、去甲肾上腺素(NE)]水平,并记录两组谵妄发生率。结果 在T0~T2时间点,两组HR、MAP呈先下降后上升趋势,RR呈先平稳后上升趋势,E呈先上升后下降趋势,NE呈持续上升趋势。两组NE变化幅度差异有统计学意义(P<0.05),在T2时间点,观察组NE水平显著低于对照组(P<0.05)。在ICU期间,观察组和对照组各发生谵妄2例,两组谵妄发生率比较差异无统计学意义(4.08% vs 4.17%;P=1.000)。在ICU期间,观察组有12例使用降压药物,对照组有11例,两组降压药物使用率比较差异无统计学意义(24.49% vs 22.92%; χ2=0.033=0.033,P=0.885)。对于使用降压药物的患者,两组降压药物使用时间及总剂量比较差异无统计学意义(P>0.05)。在使用降压药物患者中,观察组E呈先上升后下降趋势,对照组E呈上升趋势;两亚组NE变化幅度差异有统计学意义(P<0.05),在T2时间点,观察组NE水平显著低于对照组(P<0.05)。在未使用降压药物患者中,观察组T2时间点HR、MAP、NE水平低于对照组,差异有统计学意义(P<0.05)。结论 使用右美托咪定镇静,拔管前后患者的血压波动更小,血浆儿茶酚胺水平更低,抑制交感神经的作用更强。
关键词:  镇静  右美托咪定  丙泊酚  机械通气  血流动力学  谵妄
DOI:10.3969/j.issn.1674-3806.2024.06.17
分类号:R 641
基金项目:北京市临床重点专科卓越项目
Comparison of the effects of dexmedetomidine and propofol on sedation in patients with short-term mechanical ventilation after elective surgery
QIAO Li1,2, YUAN Hongxun2, ZHAO Huiying1, WANG Zheng2, AN Youzhong1
1.Department of Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China; 2. Department of Critical Care Medicine, Peking University International Hospital, Beijing 102206, China
Abstract:
[Abstract] Objective To compare the effects of dexmedetomidine and propofol on sedation in patients with short-term mechanical ventilation after elective surgery. Methods A total of 97 patients who were returned to the intensive care unit(ICU) with tracheal intubation after surgery under general anesthesia in Peking University International Hospital from April 1, 2022 to November 30, 2023 were recruited. All the patients underwent short-term(<24 hours) tracheal intubation mechanical ventilation, continuous sedation and analgesia. The patients were divided into observation group(49 cases, intervention with dexmedetomidine) and control group(48 cases, intervention with propofol) by using random number table method. The use of antihypertensive drugs(nicardipine hydrochloride) during ICU observation was recorded in the two groups. The vital signs indicators[heart rate(HR), respiratory rate(RR), mean arterial pressure(MAP)], plasma catecholamine[epinephrine(E), norepinephrine(NE)] levels before sedation(T0), 1 hour after sedation(T1) and 2 hours after tracheal extubation(T2) between the two groups and between the subgroups using antihypertensive drugs, and the incidence of delirium was recorded in the two groups. Results At the time points from T0 to T2, HR and MAP showed a downward trend and then an upward trend, and RR showed a stable trend and then an upward trend, and E showed an upward trend and then a downward trend and NE showed a continuous upward trend in the two groups, and there was statistically significant difference in the changing amplitude of NE between the two groups(P<0.05), and at the time point of T2, the NE level in the observation group was significantly lower than that in the control group(P<0.05). During ICU period, there were 2 cases of delirium in the observation group and 2 cases in the control group, and there was no significant difference in the incidence of delirium between the two groups(4.08% vs 4.17%; P=1.000). There were 12 patients in the observation group and 11 patients in the control group who used antihypertensive drugs during ICU period, and there was no statistically significant difference in the utilization rate of antihypertensive drugs between the two groups(24.49% vs 22.92%; χ2=0.033, P=0.885). For the patients using antihypertensive drugs, there were no significant differences in the duration of antihypertensive medication use and the total dose of antihypertensive drugs between the two groups(P>0.05). Among the patients using antihypertensive drugs, E in the observation group showed an upward trend and then a downward trend, while E in the control group showed an upward trend, and there was statistically significant difference in the changing amplitude of NE between the two subgroups(P<0.05), and at the time point of T2, the NE level of the observation group was significantly lower than that of the control group(P<0.05). In the patients who did not use antihypertensive drugs, the levels of HR, MAP and NE at the time point of T2 in the observation group were lower than those in the control group, and the differences were statistically significant between the two groups(P<0.05). Conclusion The use of dexmedetomidine for sedation results in less blood pressure fluctuations, lower plasma catecholamine levels and stronger inhibition of the sympathetic nervous system in patients before and after extubation.
Key words:  Sedation  Dexmedetomidine  Propofol  Mechanical ventilation  Hemodynamics  Delirium