右美托咪定對(duì)老年術(shù)后機(jī)械通氣患者睡眠與認(rèn)知功能的影響
發(fā)布時(shí)間：2019-03-02 16:01
【摘要】：目的:評(píng)估右美托咪定對(duì)ICU老年術(shù)后機(jī)械通氣患者睡眠、認(rèn)知功能的影響。比較右美托咪定與咪達(dá)唑侖對(duì)擇期老年術(shù)后機(jī)械通氣患者淺鎮(zhèn)靜治療短期及長(zhǎng)期睡眠質(zhì)量和認(rèn)知功能影響的差異。方法:將重癥監(jiān)護(hù)室腹腔腫瘤行下腹部手術(shù)的老年術(shù)后機(jī)械通氣患者60例,隨機(jī)分為右美托咪定組(Dex組)咪達(dá)唑侖組(Mi組)各30例。每位患者常規(guī)給予芬太尼持續(xù)泵入鎮(zhèn)痛,Dex組以負(fù)荷劑量1.0μg/kg/h泵入右美托咪定10分鐘,繼以0.2~1.0 ug/kg/h速率持續(xù)泵入。Mi組以0.02~0.10 mg/kg/h速率持續(xù)泵入咪達(dá)唑侖。兩組均維持Richmond躁動(dòng)-鎮(zhèn)靜評(píng)分(RASS)㧟2~0分,同期行BIS監(jiān)測(cè)鎮(zhèn)靜深度、維持BIS值在65~85淺鎮(zhèn)靜狀態(tài)。以PSG多導(dǎo)睡眠檢測(cè)儀記錄患者術(shù)后轉(zhuǎn)入ICU第一夜22:00點(diǎn)至次日6:00點(diǎn)期間睡眠腦電圖,并記錄兩組患者ICU期間不良事件(意外脫管事件,心血管事件,呼吸抑制事件)發(fā)生次數(shù)。以ICU意識(shí)模糊評(píng)估法(CAM-ICU)評(píng)估兩組患者術(shù)后7天內(nèi)譫妄的發(fā)生例數(shù)。比較兩組患者機(jī)械通氣及拔管時(shí)間,ICU留住時(shí)間,術(shù)后總住院時(shí)間。分別于術(shù)前一天(T-1)、術(shù)后第1天(T-2)、術(shù)后第3天(T-3)、術(shù)后第7天(T-4)及術(shù)后第14天(T-5)評(píng)估簡(jiǎn)易精神狀態(tài)評(píng)價(jià)量表(MMSE)。以匹茲堡睡眠質(zhì)量指數(shù)(PSQI)和MMSE量表隨訪患者90天睡眠質(zhì)量及認(rèn)知功能狀態(tài)。結(jié)果:1.Dex組睡眠效率、深度睡眠N3期占比(N3%TST)、快速動(dòng)眼睡眠占比(REM%TST)均明顯高于Mi組(t=0.04~3.44,P0.05),N1期睡眠占比(N1%TST)、非快速動(dòng)眼期睡眠占比(NREM%)、覺(jué)醒指數(shù)(次/h)均明顯低于Mi組(t=㧟2.83~㧟3.73,P0.05),兩組比較N2期睡眠占比(N2%TST)無(wú)明顯差異(P0.05)。2.術(shù)后7天內(nèi)譫妄發(fā)生率比較(Dex組13.3%VS Mi組36.7%),Dex組較Mi組患者顯著減少(?2=4.283,P0.05),兩組術(shù)后7天內(nèi)總的譫妄發(fā)生率為25%。3.兩組患者留住ICU期間不良事件發(fā)生率無(wú)明顯差異(P0.05)。4.Dex組機(jī)械通氣時(shí)間、拔管時(shí)間、留住ICU時(shí)間均明顯少于Mi組患者(t=-0.63~-1.81,P0.05),但兩組患者術(shù)后住院總時(shí)間無(wú)明顯差異(P0.05)。5.兩種鎮(zhèn)靜藥物及5個(gè)時(shí)間點(diǎn)間認(rèn)知功能MMSE評(píng)分有顯著差異(F=7.41、180.79,P0.05)。Mi組較Dex組T2時(shí)MMSE評(píng)分降低顯著(t=2.63,P0.05),T3、T4時(shí)恢復(fù)緩慢(t=4.21、3.77,P0.05)。DEX組患者術(shù)后第7天MMSE評(píng)分已升高至術(shù)前水平(P0.05),Mi組至術(shù)后第14天認(rèn)知功能評(píng)分才恢復(fù)至術(shù)前水平(P0.05)。Dex組術(shù)后T2、T3、T4時(shí)間點(diǎn)MMSE評(píng)分均明顯高于Mi組(t=2.63~4.21,P0.05),T5時(shí)兩組MMSE評(píng)分無(wú)明顯差異(P0.05)。6.兩組術(shù)后認(rèn)知功能下降例數(shù)及比例比較,Dex組較Mi組T2、T4時(shí)明顯減少(?2=㧟4.28、㧟7.80,P0.05),T3、T5時(shí)兩組無(wú)明顯差異(P0.05)。7.兩組患者術(shù)后90天MMSE評(píng)分及PSQI無(wú)明顯差異(P0.05)。結(jié)論:1.老年術(shù)后ICU機(jī)械通氣患者給予右美托咪定或咪達(dá)唑侖淺鎮(zhèn)靜治療,右美托咪定較咪達(dá)唑侖鎮(zhèn)靜誘導(dǎo)睡眠效率高,覺(jué)醒減少,快速動(dòng)眼睡眠(REM期)、深度睡眠(N3期)較咪達(dá)唑侖比例高。2.右美托咪定較咪達(dá)唑侖降低術(shù)后老年患者譫妄發(fā)生率。降低機(jī)械通氣時(shí)間、拔管時(shí)間、留住ICU時(shí)間,但并不降低術(shù)后總住院天數(shù)。3.老年擇期術(shù)后短期機(jī)械通氣患者鎮(zhèn)靜右美托咪定為較理想選擇。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614
本文編號(hào)：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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 李建國(guó);;以鎮(zhèn)痛為基礎(chǔ)的鎮(zhèn)靜[J];中華內(nèi)科雜志;2013年04期
2 邱海波;;重癥患者的鎮(zhèn)痛和鎮(zhèn)靜:以疾病為導(dǎo)向[J];中華內(nèi)科雜志;2013年04期
3 馬曉春;肇冬梅;;鎮(zhèn)痛和鎮(zhèn)靜的規(guī)范化與個(gè)體化治療[J];中華內(nèi)科雜志;2013年04期
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