CAJ | 학술논문

目的：探究右美托咪定对呼吸功能不全患者的镇静效果。方法选取2012年3月至2014年2月来我院就诊的呼吸功能不全需行机械通气患者98例，依据分层随机分组法将患者分为治疗组及对照组，每组49例。给予对照组咪达唑仑联合瑞芬太尼及常规治疗方案进行治疗；治疗组在对照组治疗方案的基础上应用右美托咪定替代咪达唑仑进行治疗。观察比较两组患者治疗前及治疗3 d后平均动脉压( MAP)、心率( HR)、自主呼吸节律( SPR)及动脉血氧分压( PaO2)；记录两组患者停药后撤机时间、停药后拔管时间、用药时间及 ICU时间；比较两组患者治疗过程中出现人机对抗、谵妄、呼吸暂停、躁动例数以及不良反应情况。结果治疗前两组患者的MAP、HR、SPR及PaO2比较差异无统计学意义(P>0．05)；治疗3 d后，治疗组患者的MAP及HR均低于对照组，治疗组患者的SPR及PaO2均高于对照组，差异有统计学意义(P<0．05)；治疗组患者停药后撤机时间、停药后拔管时间、用药时间及ICU时间均短于对照组( P<0．05)；治疗组出现人机对抗及谵妄例数均低于对照组(P<0．05)；治疗组出现低血压例数明显高于对照组，肌肉强直、恶心呕吐及静脉炎例数均低于对照组，差异有统计学意义(P<0．05)。结论应用右美托咪定替代咪达唑仑对呼吸功能不全需行机械通气患者进行镇静处理可明显改善患者临床症状，降低不良事件发生率及不良反应程度，但出现的少数血压明显降低患者则需进行对症处理。
목적：탐구우미탁미정대호흡공능불전환자적진정효과。방법선취2012년3월지2014년2월래아원취진적호흡공능불전수행궤계통기환자98례，의거분층수궤분조법장환자분위치료조급대조조，매조49례。급여대조조미체서륜연합서분태니급상규치료방안진행치료；치료조재대조조치료방안적기출상응용우미탁미정체대미체서륜진행치료。관찰비교량조환자치료전급치료3 d후평균동맥압( MAP)、심솔( HR)、자주호흡절률( SPR)급동맥혈양분압( PaO2)；기록량조환자정약후철궤시간、정약후발관시간、용약시간급 ICU시간；비교량조환자치료과정중출현인궤대항、섬망、호흡잠정、조동례수이급불량반응정황。결과치료전량조환자적MAP、HR、SPR급PaO2비교차이무통계학의의(P>0．05)；치료3 d후，치료조환자적MAP급HR균저우대조조，치료조환자적SPR급PaO2균고우대조조，차이유통계학의의(P<0．05)；치료조환자정약후철궤시간、정약후발관시간、용약시간급ICU시간균단우대조조( P<0．05)；치료조출현인궤대항급섬망례수균저우대조조(P<0．05)；치료조출현저혈압례수명현고우대조조，기육강직、악심구토급정맥염례수균저우대조조，차이유통계학의의(P<0．05)。결론응용우미탁미정체대미체서륜대호흡공능불전수행궤계통기환자진행진정처리가명현개선환자림상증상，강저불량사건발생솔급불량반응정도，단출현적소수혈압명현강저환자칙수진행대증처리。
Objective To explore the sedative efficacy of dexmedetomidine on patients with respiratory insuf-ficiency. Methods Ninty-eight cases of respiratory insufficiency patients required mechanical ventilation in our hospi-tal from March 2012 to February 2014 were divided into treatment group and control group according to the stratified randomization method. Patients of control group (n=49)were given midazolam combined with remifentanil and con-ventional treatment programs for treatment. Patients of treatment group(n=49) were given dexmedetomidine alterna-tive midazolam on the basis of the control group for treatment. The mean arterial pressure(MAP),heart rate(HR),spontaneous breathing rhythm( SPR) and arterial oxygen tension( PaO2 ) of the two groups were compared before and 3 days after treatment. The discontinued retreat local time,stopping to pull tube time,administration time and ICU time of the two groups were recorded after withdrawal. The HMI confrontation,delirium,apnea occurred,the number of cases of restlessness and adverse reactions of the two groups were compared during treatment. Results There was no signifi-cant difference in MAP,HR,SPR and PaO2 between the two groups before treatment(P>0. 05). MAP and HR of treat-ment group were lower than control group after 3 days treatment,SPR and PaO2 of treatment group were higher than control group after 3 days treatment ( P <0. 05 ) . The discontinued retreat local time, extubation time after treatment, medication and ICU time of treatment group were less than control group(P<0. 05). The number of cases of delirium and apnea of treatment group were lower than control group(P<0. 05). The number of hypotension of treatment group was significantly higher than that in control group during the treatment,the muscle rigidity,nausea and vomiting and the number of phlebitis of treatment group were lower than those of control group(P<0. 05). Conclusion Application of dexmedetomidine alternative midazolam for respiratory insufficiency patients requiring mechanical ventilation can sig-nificantly improve the clinical symptoms and reduce the incidence of adverse events and adverse reaction degree,but the patients with low blood pressure which were led by dexmedetomidine require symptomatic treatment.