CAJ | 학술논문

目的比较轻度镇静和常规镇静对重症监护病房(ICU)机械通气患者预后和炎症水平的影响.方法采用前瞻性随机对照研究,将2011年9月至2013年12月江苏大学附属人民医院ICU的78例机械通气患者分为轻度镇静组(38例)和常规镇静组(40例).比较两组镇静药物剂量、机械通气时间、ICU住院时间、ICU病死率、并发症(呼吸机相关肺炎、气胸)和不良反应(患者意外拔管、再次插管、气管切开)发生率,并测定入住ICU 48 h炎症指标.结果轻度镇静组机械通气时间[(8±5)d]、ICU住院时间[(12±10)d]、镇静镇痛药物人均总剂量[咪达唑仑(275 ± 85)mg,丙泊酚(4 562±1 128)mg,芬太尼(2 332±1 458)μg]、呼吸机相关肺炎发生率(26％,10/38)和气管切开率(18％,7/38)明显低于常规镇静组[机械通气时间(13±8)d、ICU住院时间(22±9)d、咪达唑仑(575±142)mg、丙泊酚(7 434±1 712) mg、芬太尼(4 124±2 743)μg、呼吸机相关肺炎发生率53％(21/40)、气管切开率48％ (19/40)],差异有统计学意义(均P＜0.05).两组患者意外拔管率、再次插管率和气压伤发生率差异无统计学意义(均P＜ 0.05).轻度镇静组炎症因子水平[IL-1为(35±12) ng/L、IL-6为(49±21)ng/L、肿瘤坏死因子(TNF)-α为(39±16) ng/L、C反应蛋白(CRP)为(95±41)mg/L]明显低于常规镇静组[IL-1为(47± 18) ng/L、IL-6为(62±27) ng/L、TNF-α为(52±25) ng/L、CRP为(125±45)mg/L],差异有统计学意义(均P＜0.05).两组ICU病死率和28 d ICU存活率差异无统计学意义(均P ＞0.05).结论轻度持续镇静可以缩短机械通气时间,减少ICU住院时间,且不增加不良反应发生率,同时减轻炎症因子生成.
목적 비교경도진정화상규진정대중증감호병방(ICU)궤계통기환자예후화염증수평적영향.방법 채용전첨성수궤대조연구,장2011년9월지2013년12월강소대학부속인민의원ICU적78례궤계통기환자분위경도진정조(38례)화상규진정조(40례).비교량조진정약물제량、궤계통기시간、ICU주원시간、ICU병사솔、병발증(호흡궤상관폐염、기흉)화불량반응(환자의외발관、재차삽관、기관절개)발생솔,병측정입주ICU 48 h염증지표.결과 경도진정조궤계통기시간[(8±5)d]、ICU주원시간[(12±10)d]、진정진통약물인균총제량[미체서륜(275 ± 85)mg,병박분(4 562±1 128)mg,분태니(2 332±1 458)μg]、호흡궤상관폐염발생솔(26％,10/38)화기관절개솔(18％,7/38)명현저우상규진정조[궤계통기시간(13±8)d、ICU주원시간(22±9)d、미체서륜(575±142)mg、병박분(7 434±1 712) mg、분태니(4 124±2 743)μg、호흡궤상관폐염발생솔53％(21/40)、기관절개솔48％ (19/40)],차이유통계학의의(균P＜0.05).량조환자의외발관솔、재차삽관솔화기압상발생솔차이무통계학의의(균P＜ 0.05).경도진정조염증인자수평[IL-1위(35±12) ng/L、IL-6위(49±21)ng/L、종류배사인자(TNF)-α위(39±16) ng/L、C반응단백(CRP)위(95±41)mg/L]명현저우상규진정조[IL-1위(47± 18) ng/L、IL-6위(62±27) ng/L、TNF-α위(52±25) ng/L、CRP위(125±45)mg/L],차이유통계학의의(균P＜0.05).량조ICU병사솔화28 d ICU존활솔차이무통계학의의(균P ＞0.05).결론 경도지속진정가이축단궤계통기시간,감소ICU주원시간,차불증가불량반응발생솔,동시감경염증인자생성.
Objective To compare the effect of slight and usual sedation on the prognosis and inflammatory marker levels in patients receiving mechanical ventilation in ICU.Methods We enrolled 78 critically ill adult patients who were undergoing mechanical ventilation and were expected to need ventilation for more than 48 h.The patients were prospectively and randomly assigned to receive:slight sedation(Richmond Agitation Sedation Score-1 to 0,n =38 patients) or usual sedation (Richmond Agitation Sedation Score-3 to-2,n =40 patients).Sedative dosages,duration of mechanical ventilation,length of ICU stay,complications (ventilator-associated pneumonia,tracheotomy),adverse reactions (accidental extubation,reintubation,barotrauma) and levels of inflammatory markers on the day of sedation time for 48 h were recorded.Results When compared with the usual sedation group,duration of mechanical ventilation(d)(8 ± 5 vs 13 ± 8,P ＜0.05) and length of ICU stay(d)(12 ± 10 vs 22 ±9,P ＜ 0.05) were significantly shorter in the slight sedation group.The total doses of midazolam (mg),propofol (mg) and fentany(μg) were lower in the slight sedation group than those in the usual sedation group(275 ±85 vs575±142,4 562±1 128 vs 7 434±1 712 and 2 332±1 458 vs 4 124±2 743,P＜0.05).Accidental extubation(5％ vs 3％),reintubation(5％ vs 10％) and barotraumas(3％ vs 8％) showed no differences between the 2 groups (P ＞ 0.05).In the slight sedation group,the incidences of ventilatorassociated pneumonia (26％ vs 53％) and tracheotomy (18％ vs 48％) were significantly decreased compared with those in the usual group.The levels of IL-1 (35 ± 12 vs 47 ± 18,P ＜ 0.05) rg/L,IL-6(49 ±21 vs 62 ±27,P＜0.05) ng/L,TNF-α(39 ±16 vs 52 ±25,P＜0.05) ng/L and CRP (95 ±41 vs 125 ± 45,P ＜ 0.05) mg/L were also lower in the slight sedation group than those in the conventional group.There were no differences in ICU mortality and 28 d-survival rate between the 2 groups.Conclusion Slight sedation was shown to reduce the length of mechanical ventilation and ICU stay.It also decreased the levels of inflammatory markers while didn' t increase the incidence of adverse reactions.