摘要
目的:为临床医生针对重症胰腺炎选择合理的镇静镇痛方案提供参考。方法:采用前瞻性对照研究,选重症急性胰腺炎合并ARDS需机械通气的65例患者,均给予静脉持续泵入芬太尼0.7~1.5μg·kg^(-1)·h^(-1)镇痛治疗,镇痛目标为重症监护疼痛观察工具(COPT)评分0~3分,每小时进行1次疼痛评分,当COPT评分>4分时追加芬太尼用量0.5μg/kg;根据镇静方法不同随机分为A组(咪达唑仑-右美托咪定序贯组)、B组(咪达唑仑-丙泊酚序贯组),分别于停咪达唑仑前1小时(T1)、序贯治疗后1小时(T2)、拔管后1小时(T3)测定患者血流动力学相关指标。比较2组患者的起效时间、停药至拔除气管插管的时间、平均动脉压及心率的变化、谵妄发生率。结果:两组镇静起效时间、平均动脉压无差异;两组间T1~T3个时段VTI(主动脉速度时间积分)、上腔静脉血氧饱和度(ScvO2)、动脉血乳酸值差异无统计学意义。A组停药至拔管时间显著短于B组。A组心动过缓发生率高于于B组。结论:咪达唑仑-右美托咪定序贯镇静在重症胰腺炎机械通气患者中效果好,对血流动力学影响较小,缩短停药至拔管时间,谵妄发生率低。
Objective To provide reference for clinicians to choose reasonable sedation and analgesia for severe pancreatitis.Methods A prospective controlled study was conducted in 65 patients with severe acute pancreatitis(SAP)complicated with ARDS who needed mechanical ventilation.Fentanyl was continuously pumped in 0.7~1.5μg·kg^(-1)·h^(-1).The analgesic goal was to score 0-3 of critical-care pain observation tool(COPT),and it was performed once an hour,and 0.5μg/kg of fentanyl was added when the COPT score was more than 4 points;The patients were divided into group A(midazolam dexmedetomidine sequential group)and group B(midazolam propofol sequential group).Hemodynamic indexes were measured 1 hour before midazolam was stopped(T1),1 hour after sequential treatment(T2)and 1 hour after extubation(T3).The onset time,the time from drug withdrawal to extubation,the changes of mean arterial pressure and heart rate,and delirium were compared between the two groups.Results There was no significant difference in the onset time of sedation and mean arterial pressure between the two groups;there was no significant difference in VTI(aortic blood flow velocity time indexl),superior vena cava oxygen saturation(ScvO2)and arterial blood lactic acid value between the two groups.The time from drug withdrawal to extubation in group A was significantly shorter than that in group B.The incidence of bradycardia in group A was higher than that in group B.Conclusion Midazolam dexmedetomidine sequential sedation in patients with severe pancreatitis with mechanical ventilation has good effect,relatively less influence on hemodynamics,and it can shorten the time from drug withdrawal to extubation,and low incidence of delirium.
作者
吴艳红
于海明
陈艳红
周煦
卢武
裴兴华
Wu Yan-hong;Yu Hai-ming;Chen Yan-hong;Zhou Xu;Lu Wu;Pei Xing-hua(Department of Critical Care Medicine,Hunan Provincial People’s Hospital,The First Af filiated Hospital of Hunan Normal University,Changsha 410005,China)
出处
《湖南师范大学学报（医学版）》
2021年第3期35-38,共4页
Journal of Hunan Normal University(Medical Sciences)
基金
湖南省卫健委科研基金资助(B2016018)。
关键词
右美托咪定
咪达唑仑
重症胰腺炎
序贯镇静
机械通气
dexmedetomidine
midazolam
severe acute pancreatitis
sedation
mechanical ventilation
作者简介
通讯作者:裴兴华,E-mail:waluo2000@163.com。
