CAJ | 학술논문

目的：探讨右美托咪定对实施无创正压通气（NPPV）的慢性阻塞性肺疾病急性加重（AECOPD）患者镇静的有效性及安全性。方法将2011年11月至2014年6月收入急诊 ICU 的共68例需 NPPV 的 AECOPD 患者随机分为镇静组及对照组，每组34例。两组患者均给予药物治疗及 NPPV ，镇静组在上述治疗的基础上给予右美托咪定首剂0．5μg／kg 的负荷量于10 min 静脉推完，然后给予0．1～0．4μg／（kg ? h）的维持量，镇静目标为Ramsay 评分2～4分。观察两组患者治疗前及治疗后24 h 的动脉血气分析指标、生理参数[呼吸频率（RR）、心率（HR）及平均动脉压（MAP）]的变化，观察两组患者呼吸机设定条件[吸入氧浓度（FiO2）、吸气相气道正压（IPAP）、呼气相气道正压（EPAP）]的变化及插管有创通气率。结果两组患者治疗前及治疗后24 h 相比动脉血气指标、RR 、HR 均明显好转（P＜0．05），镇静组以上监测指标较对照组改善更明显（P ＜0．05）。两组患者治疗前后相比， MAP 均有下降（P＜0．05），但两组间相比差异无统计学意义（P ＞0．05）。呼吸机设定条件（FiO2、IPAP 、EPAP）镇静组较对照组下降（P＜0．05）。镇静组插管有创通气率（10．5％）明显低于对照组（38．1％），差异有统计学意义（P＜0．05）。结论右美托咪定镇静改善 AECOPD 患者 NPPV 的依存性及疗效，减少有创通气率。
목적：탐토우미탁미정대실시무창정압통기（NPPV）적만성조새성폐질병급성가중（AECOPD）환자진정적유효성급안전성。방법장2011년11월지2014년6월수입급진 ICU 적공68례수 NPPV 적 AECOPD 환자수궤분위진정조급대조조，매조34례。량조환자균급여약물치료급 NPPV ，진정조재상술치료적기출상급여우미탁미정수제0．5μg／kg 적부하량우10 min 정맥추완，연후급여0．1～0．4μg／（kg ? h）적유지량，진정목표위Ramsay 평분2～4분。관찰량조환자치료전급치료후24 h 적동맥혈기분석지표、생리삼수[호흡빈솔（RR）、심솔（HR）급평균동맥압（MAP）]적변화，관찰량조환자호흡궤설정조건[흡입양농도（FiO2）、흡기상기도정압（IPAP）、호기상기도정압（EPAP）]적변화급삽관유창통기솔。결과량조환자치료전급치료후24 h 상비동맥혈기지표、RR 、HR 균명현호전（P＜0．05），진정조이상감측지표교대조조개선경명현（P ＜0．05）。량조환자치료전후상비， MAP 균유하강（P＜0．05），단량조간상비차이무통계학의의（P ＞0．05）。호흡궤설정조건（FiO2、IPAP 、EPAP）진정조교대조조하강（P＜0．05）。진정조삽관유창통기솔（10．5％）명현저우대조조（38．1％），차이유통계학의의（P＜0．05）。결론우미탁미정진정개선 AECOPD 환자 NPPV 적의존성급료효，감소유창통기솔。
Objective To study the effectiveness and safety of dexmedetomidine in sedation during non‐inva‐sive positive pressure ventilation(NPPV) for the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) .Methods 68 patients with AECOPD needing NPPV admitted in emergency ICU of the hospital from November 2011 to July 2014 were divide into the sedation group(34 cases) and the control group (34 cases) .All patients in the two groups were given the conventional treatment and NPPV ,while on this basis in the sedation group was given the initial dose of dexmedetomidine 0 .5 μg/kg by intravenously injected within 10 min ,then maintenance dose of dexmedetomidine 0 .1 - 0 .4 μg /(kg ? h) for maintaining the Ramsay Sedation Scale(RSS) score at 2 - 4 .The changes of arterial blood gas analysis indexes and physiological parameters(HR ,MAP ,RR) before treatment and at 24 h after treatment were observed in the two groups .The change of breathing machine setting conditions (FiO2 , IPAP ,EPAP) and the intubation invasive ventilation rate were also observed .Results The arterial blood gas inde‐xes ,HR and after 24 h treatment in the two groups were improved compared with before treatment(P < 0 .05) ,but the improvement of above indexes in the observation group was more significant than that in the control group(P<0 .05) .MAP after treatment in the two group was decreased compared with before treatment (P < 0 .05) ,but the difference between the two groups had no statistical significance(P> 0 .05) .The breathing machine setting conditions (FiO2 ,IPAP ,EPAP) after treatment in the sedation group were decreased compared with the control group( P<0 .05) .The intubation invasive ventilation rate in the sedation group was 10 .5% ,which was significantly lower than 38 .1% in the control group (P < 0 .05) .Conclusion The dexmedetomidine sedation improves the compliance of NPPV and reduces the invasive ventilation rate .