【摘要】：目的：根據(jù)人體正常生物鐘晝夜節(jié)律的睡眠/清醒的特點,通過動態(tài)監(jiān)測、控制患者鎮(zhèn)靜深度,模擬正常生物鐘使患者表現(xiàn)為白天清醒、夜間睡眠的鎮(zhèn)靜方法,探討模擬人體生物鐘鎮(zhèn)靜與ICU機械通氣患者譫妄的發(fā)生、疾病預(yù)后的相關(guān)性；為ICU機械通氣患者選擇合理有效的鎮(zhèn)靜方法、鎮(zhèn)靜藥物及劑量,降低譫妄及其它并發(fā)癥的發(fā)生率,從而改善患者的預(yù)后。方法：選取2014年7月至2015年2月入住本院ICU接受機械通氣治療時間≥12h的患者84例納入研究,其中14例患者因嚴重的不良反應(yīng)或不能達到滿意的鎮(zhèn)靜效果而被剔除,最終70例患者納入本研究。所有納入研究的患者常規(guī)應(yīng)用芬太尼鎮(zhèn)痛治療,將患者隨機分為模擬生物鐘組(A組)與非模擬生物鐘組(B組),依據(jù)使用鎮(zhèn)靜藥物的不同(右美托咪定、丙泊酚,右美托咪定+丙泊酚)進一步分為6個組,即A1、B1使用右美托咪定鎮(zhèn)靜,A2、B2使用丙泊酚鎮(zhèn)靜,A3、B3使用右美托咪定+丙泊酚聯(lián)合鎮(zhèn)靜；同時應(yīng)用VAS視覺模擬評分標準、RASS鎮(zhèn)靜程度評估表對鎮(zhèn)痛鎮(zhèn)靜的深度進行量化控制,滴定式調(diào)節(jié)鎮(zhèn)靜藥物的劑量,使模擬生物鐘組RASS評分白天維持在0～1分,夜間維持在-1～-2分；非模擬生物鐘組RASS評分晝夜維持在-1～-2分；同時采用ELISA法監(jiān)測兩組患者尿液6-羥基硫酸褪黑素(aMT6s)水平,總結(jié)晝夜變化節(jié)律并進行對比；比較兩組患者譫妄及其它不良反應(yīng)的發(fā)生率、機械通氣時間、拔管時間、ICU住院時間、鎮(zhèn)靜鎮(zhèn)痛藥物劑量是否存在差異。結(jié)果：(1)6組患者性別、年齡、急性生理學(xué)與慢性健康狀態(tài)評分系統(tǒng)Ⅱ (APACHEⅡ)評分等基礎(chǔ)狀態(tài)無明顯差異(P0.05),各組之間具有可比性。(2)模擬人體生物鐘組與非模擬人體生物鐘對比,通過動態(tài)監(jiān)測尿液中aMT6s濃度,前者尿液中6AM檢測的aMT6s水平較后者有增高趨勢,但無統(tǒng)計學(xué)意義。(3)模擬人體生物鐘組與非模擬人體生物鐘組對比,譫妄發(fā)生率明顯降低(P0.05)；A1與B1對比,A2與B2對比,A3與B3對比,機械通氣時間、拔管時間、ICU住院時間均縮短,使用鎮(zhèn)靜藥物劑量減少(P0.05)。(4)鎮(zhèn)靜藥物組間對比,右美托咪定可降低譫妄的發(fā)生率(P0.05)。(5)譫妄的發(fā)生與機械通氣時間、拔管時間、ICU住院時間呈正相關(guān)(P0.05)。結(jié)論：(1)ICU機械通氣患者譫妄的發(fā)生與患者機械通氣時間、拔管時間、ICU住院時間呈正相關(guān)。(2)模擬人體生物鐘鎮(zhèn)靜可減少ICU機械通氣患者機械通氣時間、拔管時間、ICU住院時間,減少鎮(zhèn)靜藥物的使用劑量,降低譫妄發(fā)生率。(3)使用右美托咪定鎮(zhèn)靜可降低譫妄的發(fā)生率,可用于譫妄的防控治療。
[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，

本文編號：2366603