中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
3期
225-228
,共4页
徐杰%马明远%潘永%宋樱花%于娜
徐傑%馬明遠%潘永%宋櫻花%于娜
서걸%마명원%반영%송앵화%우나
右美托咪定%肺挫伤%机械通气%血管外肺水指数%氧合指数
右美託咪定%肺挫傷%機械通氣%血管外肺水指數%氧閤指數
우미탁미정%폐좌상%궤계통기%혈관외폐수지수%양합지수
Dexmedetomidine%Pulmonary contusion%Mechanical ventilation%Extravacular lung water index%Oxygenation index
目的：探讨右美托咪定对肺挫伤机械通气患者的保护作用。方法采用前瞻性随机对照临床研究方法，选择2010年1月至2012年12月入住广东省佛山市中医院重症医学科肺挫伤机械通气患者70例，随机分为对照组和治疗组，每组35例。两组均按相同原则进行综合治疗，同时对照组给予咪达唑仑镇静，治疗组给予右美托咪定镇静。分别监测两组患者治疗后1 d、5 d氧合指数（PaO2/FiO2）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）以及血管外肺水指数（EVLWI）的变化。统计治疗期间两组谵妄发生率、机械通气时间、低血压发生率等。结果与治疗后1 d比较，两组治疗后5 d TNF-α、IL-6、EVLWI均明显降低〔对照组 TNF-α（ng/L）：1.29±0.38比2.21±0.37，IL-6（ng/L）：97.97±28.77比131.03±41.52，EVLWI（mL/kg）：8.25±2.03比11.96±3.36；治疗组TNF-α：1.06±0.33比2.32±0.37，IL-6：82.07±23.35比134.98±64.25， EVLWI（mL/kg）：6.74±1.33比11.23±2.78，均P＜0.05〕，PaO2/FiO2明显升高〔mmHg（1 mmHg＝0.133 kPa），对照组：285.80±30.65比213.00±33.70，治疗组：315.00±34.50比229.50±37.00，均P＜0.05〕，治疗组和对照组TNF-α、IL-6变化程度相当，差异无统计学意义（TNF-α：1.06±0.33比1.29±0.38，IL-6：82.07±23.35比97.97±28.77），但治疗组EVLWI和PaO2/FiO2变化较对照组显著〔EVLWI（mL/kg）：6.74±1.33比8.25±2.03， PaO2/FiO2（mmHg）：315.00±34.50比285.80±30.65，均P＜0.05〕。治疗组谵妄发生率（8.57%比22.86%）、机械通气时间（d：4.10±1.09比6.88±1.66）较对照组明显下降；治疗组和对照组患者低血压发生率比较差异无统计学意义（17.14%比14.29%，P＞0.05）。结论右美托咪定对肺挫伤机械通气患者有保护作用，是此类患者较理想的镇静药物。
目的：探討右美託咪定對肺挫傷機械通氣患者的保護作用。方法採用前瞻性隨機對照臨床研究方法，選擇2010年1月至2012年12月入住廣東省彿山市中醫院重癥醫學科肺挫傷機械通氣患者70例，隨機分為對照組和治療組，每組35例。兩組均按相同原則進行綜閤治療，同時對照組給予咪達唑崙鎮靜，治療組給予右美託咪定鎮靜。分彆鑑測兩組患者治療後1 d、5 d氧閤指數（PaO2/FiO2）、腫瘤壞死因子-α（TNF-α）、白細胞介素-6（IL-6）以及血管外肺水指數（EVLWI）的變化。統計治療期間兩組譫妄髮生率、機械通氣時間、低血壓髮生率等。結果與治療後1 d比較，兩組治療後5 d TNF-α、IL-6、EVLWI均明顯降低〔對照組 TNF-α（ng/L）：1.29±0.38比2.21±0.37，IL-6（ng/L）：97.97±28.77比131.03±41.52，EVLWI（mL/kg）：8.25±2.03比11.96±3.36；治療組TNF-α：1.06±0.33比2.32±0.37，IL-6：82.07±23.35比134.98±64.25， EVLWI（mL/kg）：6.74±1.33比11.23±2.78，均P＜0.05〕，PaO2/FiO2明顯升高〔mmHg（1 mmHg＝0.133 kPa），對照組：285.80±30.65比213.00±33.70，治療組：315.00±34.50比229.50±37.00，均P＜0.05〕，治療組和對照組TNF-α、IL-6變化程度相噹，差異無統計學意義（TNF-α：1.06±0.33比1.29±0.38，IL-6：82.07±23.35比97.97±28.77），但治療組EVLWI和PaO2/FiO2變化較對照組顯著〔EVLWI（mL/kg）：6.74±1.33比8.25±2.03， PaO2/FiO2（mmHg）：315.00±34.50比285.80±30.65，均P＜0.05〕。治療組譫妄髮生率（8.57%比22.86%）、機械通氣時間（d：4.10±1.09比6.88±1.66）較對照組明顯下降；治療組和對照組患者低血壓髮生率比較差異無統計學意義（17.14%比14.29%，P＞0.05）。結論右美託咪定對肺挫傷機械通氣患者有保護作用，是此類患者較理想的鎮靜藥物。
목적：탐토우미탁미정대폐좌상궤계통기환자적보호작용。방법채용전첨성수궤대조림상연구방법，선택2010년1월지2012년12월입주광동성불산시중의원중증의학과폐좌상궤계통기환자70례，수궤분위대조조화치료조，매조35례。량조균안상동원칙진행종합치료，동시대조조급여미체서륜진정，치료조급여우미탁미정진정。분별감측량조환자치료후1 d、5 d양합지수（PaO2/FiO2）、종류배사인자-α（TNF-α）、백세포개소-6（IL-6）이급혈관외폐수지수（EVLWI）적변화。통계치료기간량조섬망발생솔、궤계통기시간、저혈압발생솔등。결과여치료후1 d비교，량조치료후5 d TNF-α、IL-6、EVLWI균명현강저〔대조조 TNF-α（ng/L）：1.29±0.38비2.21±0.37，IL-6（ng/L）：97.97±28.77비131.03±41.52，EVLWI（mL/kg）：8.25±2.03비11.96±3.36；치료조TNF-α：1.06±0.33비2.32±0.37，IL-6：82.07±23.35비134.98±64.25， EVLWI（mL/kg）：6.74±1.33비11.23±2.78，균P＜0.05〕，PaO2/FiO2명현승고〔mmHg（1 mmHg＝0.133 kPa），대조조：285.80±30.65비213.00±33.70，치료조：315.00±34.50비229.50±37.00，균P＜0.05〕，치료조화대조조TNF-α、IL-6변화정도상당，차이무통계학의의（TNF-α：1.06±0.33비1.29±0.38，IL-6：82.07±23.35비97.97±28.77），단치료조EVLWI화PaO2/FiO2변화교대조조현저〔EVLWI（mL/kg）：6.74±1.33비8.25±2.03， PaO2/FiO2（mmHg）：315.00±34.50비285.80±30.65，균P＜0.05〕。치료조섬망발생솔（8.57%비22.86%）、궤계통기시간（d：4.10±1.09비6.88±1.66）교대조조명현하강；치료조화대조조환자저혈압발생솔비교차이무통계학의의（17.14%비14.29%，P＞0.05）。결론우미탁미정대폐좌상궤계통기환자유보호작용，시차류환자교이상적진정약물。
Objective To approach the protective effect of dexmedetomidine on mechanically ventilated patients with pulmonary contusion. Methods A prospective randomly controlled trial was conducted. 70 mechanically ventilated patients with pulmonary contusion from January 2010 to December 2012 in the Critical Care Medicine of Foshan Hospital of Traditional Chinese Medicine were divided into a control group and a therapy group by the difference in number odd or even,with 35 patients in each group. Based on the same principles of comprehensive treatment,the control group used midazolam,and the therapy group used dexmedetomidine for sedation. The measured parameters included oxygenation index(PaO2/FiO2),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6), and extra-vacular lung water index(EVLWI)for both groups on the1st and 5th day. The incidence of delirium,the time of mechanical ventilation,and the incidence of hypotension were observed in both groups. Results Compared with those on the 1st day,TNF-α,IL-6 and EVLWI on the 5th day were decreased significantly in both groups〔the control group TNF-α(ng/L):1.29±0.38 vs. 2.21±0.37,IL-6(ng/L):97.97±28.77 vs. 131.03±41.52,EVLWI (mL/kg):8.25±2.03 vs. 11.96±3.36;the therapy group TNF-α:1.06±0.33 vs. 2.32±0.37,IL-6:82.07±23.35 vs. 134.98±64.25, EVLWI(mL/kg):6.74±1.33 vs. 11.23±2.78, all P<0.05〕, PaO2/FiO2 was increased obviously〔mmHg(1 mmHg=0.133 kPa),the control group:285.80±30.65 vs. 213.00±33.70,the therapy group:315.00±34.50 vs. 229.50±37.00,both P<0.05〕,TNF-αand IL-6 had no significant difference compared between the therapy group and control group(TNF-α:1.06±0.33 vs. 1.29±0.38,IL-6:82.07±23.35 vs. 97.97±28.77), while EVLWI and PaO2/FiO2 in the therapy group had remarkable differences compared with those of the control group〔EVLWI(mL/kg):6.74±1.33 vs. 8.25±2.03,PaO2/FiO2(mmHg):315.00±34.50 vs. 285.80±30.65,both P<0.05〕. The incidence of delirium(8.57% vs. 22.86%)and time of mechanical ventilation(day:4.10±1.09 vs. 6.88±1.66)in the therapy group were decreased markedly compared with those of the control group,and the incidence of hypotension had no significant difference between treatment or control groups(17.14% vs. 14.29%,P>0.05). Conclusion Dexmedetomidine has protective effect on mechanically ventilated patients with pulmonary contusion, and it is an relatively ideal sedative drug for these patients.
