中国医药
中國醫藥
중국의약
China Medicine
2015年
11期
1687-1691
,共5页
钱何布%赵宏胜%管光辉%浦秦华%梅婉雯
錢何佈%趙宏勝%管光輝%浦秦華%梅婉雯
전하포%조굉성%관광휘%포진화%매완문
重症患者%右美托咪定%镇静%全身炎症反应综合征
重癥患者%右美託咪定%鎮靜%全身炎癥反應綜閤徵
중증환자%우미탁미정%진정%전신염증반응종합정
Critical patients%Dexmedetomidine%Sedation%Systemic inflammatory response syndrome
目的 探讨右美托眯定镇静治疗对重症患者全身炎性反应的影响.方法 将2013年1月至2014年2月江苏省苏州市吴江区第一人民医院60例接受机械通气治疗的重症监护病房(ICU)住院患者按照随机数字表法分为观察组和对照组,各30例.同期选取健康成人志愿者20人为健康对照组.2组患者均在常规治疗基础上给予镇静治疗,必要时给予瑞芬太尼镇痛治疗.观察组给予右美托咪定负荷剂量1 μg/kg,后以0.20 ～0.75μg/(kg·h)维持;对照组给予咪达唑仑负荷剂量0.1 mg/kg,后以0.05～0.20 mg/(kg·h)维持.比较2组患者治疗前和治疗24、48 h的全身炎症反应综合征(SIRS)评分,并在这3个时点抽取静脉血测定血浆C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)的浓度.比较2组患者机械通气时间、ICU住院时间、多器官功能障碍综合征(MODS)发生率和28 d病死率.结果 治疗前,对照组与观察组患者TNF-α、IL-6和CRP浓度均明显高于健康对照组[(25.9±12.1)、(26.5 ±12.3) ng/L比(3.6±1.9) ng/L, (200.3±135.O)、(202.6±139.3) ng/L比(3.0±1.9) ng/L,(126.4±51.9)、(138.4 ±51.8) mg/L比(3.8±2.5)mg/L],差异均有统计学意义(均P＜0.05).观察组治疗48 h SIRS评分、TNF-α、IL-6、CRP水平均明显低于对照组[(1.3±0.5)分比(2.4±0.6)分、(12.3±6.8) ng/L比(23.2±11.2) ng/L、(53.0±33.1)ng/L比(168.2±113.8) ng/L、(29.2±11.4) mg/L比(95.5±42.3) mg/L],差异均有统计学意义(均P＜0.05).观察组患者机械通气时间、ICU住院时间、MODS发生率均明显低于对照组[(4.9±2.6)d比(8.0 ±2.3)d、(8±3)d比(12±3)d、6.7％ (2/30)比30.0％ (9/30)],差异均有统计学意义(均P＜0.05).结论 右美托咪定镇静治疗能有效降低重症患者血浆炎症因子水平,减轻全身炎性反应,并改善预后.
目的 探討右美託瞇定鎮靜治療對重癥患者全身炎性反應的影響.方法 將2013年1月至2014年2月江囌省囌州市吳江區第一人民醫院60例接受機械通氣治療的重癥鑑護病房(ICU)住院患者按照隨機數字錶法分為觀察組和對照組,各30例.同期選取健康成人誌願者20人為健康對照組.2組患者均在常規治療基礎上給予鎮靜治療,必要時給予瑞芬太尼鎮痛治療.觀察組給予右美託咪定負荷劑量1 μg/kg,後以0.20 ～0.75μg/(kg·h)維持;對照組給予咪達唑崙負荷劑量0.1 mg/kg,後以0.05～0.20 mg/(kg·h)維持.比較2組患者治療前和治療24、48 h的全身炎癥反應綜閤徵(SIRS)評分,併在這3箇時點抽取靜脈血測定血漿C反應蛋白(CRP)、腫瘤壞死因子α(TNF-α)和白細胞介素6(IL-6)的濃度.比較2組患者機械通氣時間、ICU住院時間、多器官功能障礙綜閤徵(MODS)髮生率和28 d病死率.結果 治療前,對照組與觀察組患者TNF-α、IL-6和CRP濃度均明顯高于健康對照組[(25.9±12.1)、(26.5 ±12.3) ng/L比(3.6±1.9) ng/L, (200.3±135.O)、(202.6±139.3) ng/L比(3.0±1.9) ng/L,(126.4±51.9)、(138.4 ±51.8) mg/L比(3.8±2.5)mg/L],差異均有統計學意義(均P＜0.05).觀察組治療48 h SIRS評分、TNF-α、IL-6、CRP水平均明顯低于對照組[(1.3±0.5)分比(2.4±0.6)分、(12.3±6.8) ng/L比(23.2±11.2) ng/L、(53.0±33.1)ng/L比(168.2±113.8) ng/L、(29.2±11.4) mg/L比(95.5±42.3) mg/L],差異均有統計學意義(均P＜0.05).觀察組患者機械通氣時間、ICU住院時間、MODS髮生率均明顯低于對照組[(4.9±2.6)d比(8.0 ±2.3)d、(8±3)d比(12±3)d、6.7％ (2/30)比30.0％ (9/30)],差異均有統計學意義(均P＜0.05).結論 右美託咪定鎮靜治療能有效降低重癥患者血漿炎癥因子水平,減輕全身炎性反應,併改善預後.
목적 탐토우미탁미정진정치료대중증환자전신염성반응적영향.방법 장2013년1월지2014년2월강소성소주시오강구제일인민의원60례접수궤계통기치료적중증감호병방(ICU)주원환자안조수궤수자표법분위관찰조화대조조,각30례.동기선취건강성인지원자20인위건강대조조.2조환자균재상규치료기출상급여진정치료,필요시급여서분태니진통치료.관찰조급여우미탁미정부하제량1 μg/kg,후이0.20 ～0.75μg/(kg·h)유지;대조조급여미체서륜부하제량0.1 mg/kg,후이0.05～0.20 mg/(kg·h)유지.비교2조환자치료전화치료24、48 h적전신염증반응종합정(SIRS)평분,병재저3개시점추취정맥혈측정혈장C반응단백(CRP)、종류배사인자α(TNF-α)화백세포개소6(IL-6)적농도.비교2조환자궤계통기시간、ICU주원시간、다기관공능장애종합정(MODS)발생솔화28 d병사솔.결과 치료전,대조조여관찰조환자TNF-α、IL-6화CRP농도균명현고우건강대조조[(25.9±12.1)、(26.5 ±12.3) ng/L비(3.6±1.9) ng/L, (200.3±135.O)、(202.6±139.3) ng/L비(3.0±1.9) ng/L,(126.4±51.9)、(138.4 ±51.8) mg/L비(3.8±2.5)mg/L],차이균유통계학의의(균P＜0.05).관찰조치료48 h SIRS평분、TNF-α、IL-6、CRP수평균명현저우대조조[(1.3±0.5)분비(2.4±0.6)분、(12.3±6.8) ng/L비(23.2±11.2) ng/L、(53.0±33.1)ng/L비(168.2±113.8) ng/L、(29.2±11.4) mg/L비(95.5±42.3) mg/L],차이균유통계학의의(균P＜0.05).관찰조환자궤계통기시간、ICU주원시간、MODS발생솔균명현저우대조조[(4.9±2.6)d비(8.0 ±2.3)d、(8±3)d비(12±3)d、6.7％ (2/30)비30.0％ (9/30)],차이균유통계학의의(균P＜0.05).결론 우미탁미정진정치료능유효강저중증환자혈장염증인자수평,감경전신염성반응,병개선예후.
Objective To investigate the effect of dexmedetomidine on systemic inflammatory response in critically ill patients.Methods Sixty critical patients receiving ventilation in intensive care unit (ICU) were randomly divided into observation group (30 cases) and control group (30 cases);20 healthy adult volunteers were selected as healthy group.The critical patients received sedation therapy on the basis of conventional treatment and analgesia therapy with remifentanil was given if necessary;observation group was additionally administrated with dexmedetomidine [loading dose 1 μg/kg, then maintained with 0.20-0.75 μg/(kg · h)];control group was additionally administrated with midazolam [loading dose 1 mg/kg, then maintained with 0.05-0.20 mg/(kg · h)].The systemic inflammatory response syndrome (SIRS) scores, the levels of serum C reactive protein (CRP), tumor necrosis factor (TNF)-α and interleukin (IL)-6 before treatment, 24 and 48 h after treatment were compared between observation and control group;the duration of mechanical ventilation, length of stay in ICU, incidence of multiple organ dysfunction syndrome (MODS) and 28 day mortality were compared between observation and control group.Results Before treatment, the levels of serum TNF-α, IL-6 and CRP in control group and observation group were significantly higher than those in healthy group [(25.9 ± 12.1), (26.5 ±12.3) ng/L vs (3.6±1.9) ng/L, (200.3±135.0), (202.6±139.3) ng/L vs (3.0±1.9)ng/L, (126.4±51.9), (138.4 ± 51.8) mg/L vs (3.8 ± 2.5) mg/L] (P ＜ 0.05).Forty eight hours after treatment, the SIRS scores and the levels of serum TNF-α, IL-6 and CRP in observation group were significantly lower than those in control group [(1.3±0.5) scores vs (2.4±0.6) scores, (12.3±6.8) ng/L vs (23.2±11.2) ng/L,(53.0±33.1) ng/Lvs (168.2±113.8) ng/L, (29.2±11.4) mg/Lvs (95.5 ±42.3) mg/L] (P＜0.05).The duration of mechanical ventilation, length of stay in ICU, incidence of MODS in observation group were significantly lower than those in control group [(4.9 ± 2.6) d vs (8.0 ± 2.3) d, (8 ± 3) d vs (12 ± 3) d, 6.7％ (2/30) vs 30.0％ (9/30)] (P ＜ 0.05).Conclusion Dexmedetomidine infusion during sedation may effectively decrease the levels of serum cytokines, prevent the inflammatory effects and improve the prognosis in critically ill patients.
