【摘要】：目的:ICU譫妄是一個(gè)容易被臨床醫(yī)師忽視的意識(shí)障礙性疾病,但其對(duì)于危重患者的臨床預(yù)后與轉(zhuǎn)歸卻有著至關(guān)重要的影響。然而,無(wú)論是譫妄發(fā)生的病理生理機(jī)制,還是預(yù)防及治療皆沒(méi)有明確的結(jié)論。目前,普遍認(rèn)為對(duì)譫妄需要進(jìn)行及時(shí)的評(píng)估和管理,尤其是對(duì)患者危險(xiǎn)因素的評(píng)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(gè)環(huán)節(jié)。正是基于以上種種理論,對(duì)于ICU機(jī)械通氣過(guò)渡拔管進(jìn)行脫機(jī)訓(xùn)練的患者選擇右美托咪定進(jìn)行鎮(zhèn)靜,觀察評(píng)估其對(duì)患者譫妄發(fā)生的影響,為機(jī)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(xué)附屬醫(yī)院重癥醫(yī)學(xué)科接受機(jī)械通氣,年齡在18-65周歲以及APACHEⅡ評(píng)分在10-40分并且評(píng)估可以試撤機(jī)的危重癥患者共196例,隨機(jī)分為2組:干預(yù)組在脫機(jī)訓(xùn)練期間給予右美托咪定鎮(zhèn)靜,對(duì)照組繼續(xù)使用咪達(dá)唑侖或者咪達(dá)唑侖和/或丙泊酚進(jìn)行鎮(zhèn)靜,觀察比較兩組譫妄發(fā)生率有無(wú)統(tǒng)計(jì)學(xué)差異。兩組機(jī)械通氣期間,均使用咪達(dá)唑侖或者咪達(dá)唑侖和/或丙泊酚鎮(zhèn)靜。所有鎮(zhèn)靜藥物使用按照標(biāo)準(zhǔn)劑量給藥。根據(jù)RASS評(píng)分評(píng)估鎮(zhèn)靜深度,隨時(shí)調(diào)節(jié)藥物劑量。觀察的指標(biāo):機(jī)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(jié)果:1.本研究納入疾病的種類,大致分為有機(jī)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(wú)統(tǒng)計(jì)學(xué)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(xiàng)的數(shù)據(jù)分析出現(xiàn)了統(tǒng)計(jì)學(xué)差異(P=0.0170.05)。2.兩組患者一般資料比較:年齡差異無(wú)統(tǒng)計(jì)學(xué)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(píng)分差異無(wú)統(tǒng)計(jì)學(xué)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(jī)械通氣天數(shù)差異無(wú)統(tǒng)計(jì)學(xué)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(jī)械通氣期間使用咪達(dá)唑侖或者咪達(dá)唑侖和/或丙泊酚,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.0630.05)。4.兩組患者生化檢查指標(biāo)的比較:高鉀血癥項(xiàng)(P=0.971)和低鉀血癥項(xiàng)(P=0.432);高鈉血癥項(xiàng)(P=0.421)和低鈉血癥項(xiàng)(P=0.431);肌酐(P=0.441);低蛋白血癥項(xiàng)(P=0.570);代謝性酸中毒項(xiàng)(P=0.140)和代謝性堿中毒項(xiàng)(P=0.955),差異均無(wú)統(tǒng)計(jì)學(xué)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(jì)學(xué)意義(P=0.0210.05)。結(jié)論:與其他鎮(zhèn)靜藥物相比較,ICU機(jī)械通氣患者撤機(jī)期間應(yīng)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(hào)：2342796