【摘要】：目的:ICU譫妄是一個容易被臨床醫(yī)師忽視的意識障礙性疾病,但其對于危重患者的臨床預后與轉(zhuǎn)歸卻有著至關重要的影響。然而,無論是譫妄發(fā)生的病理生理機制,還是預防及治療皆沒有明確的結論。目前,普遍認為對譫妄需要進行及時的評估和管理,尤其是對患者危險因素的評估和消除。這其中ICU患者的鎮(zhèn)靜策略和鎮(zhèn)靜藥物的選擇成為十分重要的一個環(huán)節(jié)。正是基于以上種種理論,對于ICU機械通氣過渡拔管進行脫機訓練的患者選擇右美托咪定進行鎮(zhèn)靜,觀察評估其對患者譫妄發(fā)生的影響,為機械通氣患者的鎮(zhèn)靜選擇提供一種依據(jù)。方法:選擇2014年1月-2017年2月期間入住延安大學附屬醫(yī)院重癥醫(yī)學科接受機械通氣,年齡在18-65周歲以及APACHEⅡ評分在10-40分并且評估可以試撤機的危重癥患者共196例,隨機分為2組:干預組在脫機訓練期間給予右美托咪定鎮(zhèn)靜,對照組繼續(xù)使用咪達唑侖或者咪達唑侖和/或丙泊酚進行鎮(zhèn)靜,觀察比較兩組譫妄發(fā)生率有無統(tǒng)計學差異。兩組機械通氣期間,均使用咪達唑侖或者咪達唑侖和/或丙泊酚鎮(zhèn)靜。所有鎮(zhèn)靜藥物使用按照標準劑量給藥。根據(jù)RASS評分評估鎮(zhèn)靜深度,隨時調(diào)節(jié)藥物劑量。觀察的指標:機械通氣天數(shù);PH、鈉離子、鉀離子、肌酐、白蛋白;譫妄發(fā)生例數(shù)。結果:1.本研究納入疾病的種類,大致分為有機磷中毒、急性胰腺炎、重度子癇前期和子癇、重癥肺炎、感染性休克、多發(fā)傷以及其他疾病。前幾種疾病,差異無統(tǒng)計學意義(P值分別為0.189、0.552、0.201、0.543、0.458、0.103)。在其他疾病一項的數(shù)據(jù)分析出現(xiàn)了統(tǒng)計學差異(P=0.0170.05)。2.兩組患者一般資料比較:年齡差異無統(tǒng)計學意義(右美托咪定組39.1214.30歲vs.非右美托咪定組41.5813.79歲,P=0.2230.05);APACHEⅡ評分差異無統(tǒng)計學意義(右美托咪定組23.756.06分vs.非右美托咪定組23.686.36分,p=0.9320.05);機械通氣天數(shù)差異無統(tǒng)計學意義[右美組9天(6~14)vs.非右美組9天(6~15),P=0.2050.05]。3.兩組患者鎮(zhèn)靜藥物使用情況分析,兩組機械通氣期間使用咪達唑侖或者咪達唑侖和/或丙泊酚,差異無統(tǒng)計學意義(P=0.0630.05)。4.兩組患者生化檢查指標的比較:高鉀血癥項(P=0.971)和低鉀血癥項(P=0.432);高鈉血癥項(P=0.421)和低鈉血癥項(P=0.431);肌酐(P=0.441);低蛋白血癥項(P=0.570);代謝性酸中毒項(P=0.140)和代謝性堿中毒項(P=0.955),差異均無統(tǒng)計學意義(P值均0.05)。5.兩組譫妄發(fā)生的比較:譫妄發(fā)生右美托咪定組5例,譫妄發(fā)生率占組內(nèi)5.2%;非右美托咪定組15例,譫妄發(fā)生率占組內(nèi)15.2%;比較兩組譫妄發(fā)生率,差異有統(tǒng)計學意義(P=0.0210.05)。結論:與其他鎮(zhèn)靜藥物相比較,ICU機械通氣患者撤機期間應用右美托咪定鎮(zhèn)靜可以減少譫妄的發(fā)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，

本文編號：2342796