舒芬太尼联合右美托咪定对AECOPD机械通气患者ICU获得性衰弱的影响-中国药房

舒芬太尼联合右美托咪定对AECOPD机械通气患者ICU获得性衰弱的影响

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篇名：	舒芬太尼联合右美托咪定对AECOPD机械通气患者ICU获得性衰弱的影响
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摘要：	目的：探讨舒芬太尼联合右美托咪定对慢性阻塞性肺疾病急性发作（AECOPD）机械通气患者重症医学科（ICU）获得性衰弱（ICU-AW）的影响。方法：选择2015年10月－2016年10月我院ICU收治的120例AECOPD患者，按随机数字表法分为A、B组，每组60例。A组患者给予舒芬太尼联合丙泊酚镇痛镇静，B组患者给予舒芬太尼联合右美托咪定镇痛镇静。观察两组患者治疗前后Richmond躁动-镇静程度评估量表（RAAS镇静程度评估量表）评分和英国医学研究委员会（MRC）量表评分，治疗7 d后ICU-AW发生率、气管拔管率和谵妄发生率，并记录两组患者被诊断为ICU-AW后滞留ICU的时间、总住院时间及不良反应发生情况。结果：治疗后，两组患者RASS镇静程度评估量表评分均较治疗前显著降低，差异有统计学意义（P＜0.05），但两组间比较差异无统计学意义（P＞0.05）；A组患者MRC量表评分较治疗前显著降低，且显著低于B组，差异均有统计学意义（P＜0.05）；B组患者治疗前后MRC量表评分比较，差异无统计学意义（P＞0.05）。治疗7 d后，B组患者ICU-AW的发生率显著低于A组（40.00％ vs. 56.67％）；B组患者的气管拔管率显著高于A组（70.00％ vs. 53.33％），谵妄发生率显著低于A组（13.33％ vs. 20.00％）；B组患者被诊断为ICU-AW后滞留ICU的时间及总住院时间均显著短于A组，差异均有统计学意义（P＜0.05）。两组患者不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论：舒芬太尼联合右美托咪定对AECOPD机械通气患者的镇痛镇静效果与舒芬太尼联合丙泊酚相当，但在对患者的肌力影响，降低患者ICU-AW和谵妄的发生率，缩短患者机械通气时间、滞留ICU的时间和总住院时间方面，舒芬太尼联合右美托咪定效果更优，且安全性相当。
ABSTRACT：	OBJECTIVE： To investigate the effects of sufentanil combined with dexmedetomidine on ICU acquired weakness （ICU-AW） of AECOPD patients receiving mechanical ventilation. METHODS： A total of 120 AECOPD patients in ICU of our hospital during Oct. 2015-Oct. 2016 were divided into group A and B according to random number tablet， with 60 cases in each group. Group A was given analgesia and sedation of sufentanil combined with propofol； group B was given analgesia and sedation of sufentanil combined with dexmedetomidine. RAAS sedation score and British Medical Research Committee （MRC） score were compared between 2 groups before treatment and 7 d after treatment. The incidence of ICU-AW， delirium and tracheal extubation were observed. The staying time in ICU， total hospitalization time and the occurrence of ADR were compared between 2 groups after diagnosed as ICU-AW. RESULTS： After treatment， the scores of RASS sedation degree scale in 2 groups were decreased significantly compared to before treatment， with statistical significance （P＜0.05）； there was no statistical significance between 2 groups （P＞0.05）. MRC score of group A was decreased significantly compared to before treatment， and significantly lower than group B， with statistical significance （P＜0.05）. There was no statistical significance in MRC score of group B before and after treatment （P＞0.05）. After 7 d of treatment， the incidence of ICU-AW in group B was significantly lower than group A （40.00％ vs. 56.67％）； the incidence of tracheal extubation in group B was significantly higher than group A （70.00％ vs. 53.33％）， the incidence of delirium was significantly lower than group A （13.33％ vs. 20.00％）； the staying time in ICU and total hospitalization time in group B after diagnosed as ICU-AW were significantly shorter than group A， with statistical significance （P＜0.05）. There was no statistical significance in the total incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： Compared with sufentanil combined with propofol， sufentanil combined with dexmedetomide shows similar analgesia and sedation effect， but has better influence on the muscle strength of the patient， reducing the incidence of ICU-AW and delirium， shortening the duration of mechanical ventilation， staying time in ICU and total hospitalization time in AECOPD patients receiving mechanical ventilation， with similar safety.
期刊：	2018年第29卷第6期
作者：	邓佳林，杨钧
AUTHORS：	DENG Jialin，YANG Jun
关键字：	舒芬太尼；右美托咪定；慢性阻塞性肺疾病急性发作；重症医学科获得性衰弱；机械通气
KEYWORDS：	Sufentanil； Dexmedetomidine； AECOPD； ICU acquired weakness； Mechanical ventilation
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