右美托咪定對老年術(shù)后機械通氣患者睡眠與認知功能的影響
發(fā)布時間：2019-03-02 16:01
【摘要】：目的:評估右美托咪定對ICU老年術(shù)后機械通氣患者睡眠、認知功能的影響。比較右美托咪定與咪達唑侖對擇期老年術(shù)后機械通氣患者淺鎮(zhèn)靜治療短期及長期睡眠質(zhì)量和認知功能影響的差異。方法:將重癥監(jiān)護室腹腔腫瘤行下腹部手術(shù)的老年術(shù)后機械通氣患者60例,隨機分為右美托咪定組(Dex組)咪達唑侖組(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)泵入咪達唑侖。兩組均維持Richmond躁動-鎮(zhèn)靜評分(RASS)㧟2~0分,同期行BIS監(jiān)測鎮(zhèn)靜深度、維持BIS值在65~85淺鎮(zhèn)靜狀態(tài)。以PSG多導睡眠檢測儀記錄患者術(shù)后轉(zhuǎn)入ICU第一夜22:00點至次日6:00點期間睡眠腦電圖,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意識模糊評估法(CAM-ICU)評估兩組患者術(shù)后7天內(nèi)譫妄的發(fā)生例數(shù)。比較兩組患者機械通氣及拔管時間,ICU留住時間,術(shù)后總住院時間。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)評估簡易精神狀態(tài)評價量表(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)、非快速動眼期睡眠占比(NREM%)、覺醒指數(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)生率無明顯差異(P0.05)。4.Dex組機械通氣時間、拔管時間、留住ICU時間均明顯少于Mi組患者(t=-0.63~-1.81,P0.05),但兩組患者術(shù)后住院總時間無明顯差異(P0.05)。5.兩種鎮(zhèn)靜藥物及5個時間點間認知功能MMSE評分有顯著差異(F=7.41、180.79,P0.05)。Mi組較Dex組T2時MMSE評分降低顯著(t=2.63,P0.05),T3、T4時恢復緩慢(t=4.21、3.77,P0.05)。DEX組患者術(shù)后第7天MMSE評分已升高至術(shù)前水平(P0.05),Mi組至術(shù)后第14天認知功能評分才恢復至術(shù)前水平(P0.05)。Dex組術(shù)后T2、T3、T4時間點MMSE評分均明顯高于Mi組(t=2.63~4.21,P0.05),T5時兩組MMSE評分無明顯差異(P0.05)。6.兩組術(shù)后認知功能下降例數(shù)及比例比較,Dex組較Mi組T2、T4時明顯減少(?2=㧟4.28、㧟7.80,P0.05),T3、T5時兩組無明顯差異(P0.05)。7.兩組患者術(shù)后90天MMSE評分及PSQI無明顯差異(P0.05)。結(jié)論:1.老年術(shù)后ICU機械通氣患者給予右美托咪定或咪達唑侖淺鎮(zhèn)靜治療,右美托咪定較咪達唑侖鎮(zhèn)靜誘導睡眠效率高,覺醒減少,快速動眼睡眠(REM期)、深度睡眠(N3期)較咪達唑侖比例高。2.右美托咪定較咪達唑侖降低術(shù)后老年患者譫妄發(fā)生率。降低機械通氣時間、拔管時間、留住ICU時間,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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614
本文編號：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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614
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相關期刊論文 前3條
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，本文編號：2433210
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