小剂量右美托咪定在重症病人中抗谵妄和降低应激水平的作用
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摘要
目的探讨小剂量右美托咪定在重症病人中抗谵妄和降低应激水平的作用。方法连续性纳入2015年10月至2016年6月内蒙古自治区人民医院收治的危重病人112例,采用随机数字表法分为观察组(56例)和对照组(56例)。两组均给予瑞芬太尼镇痛,观察组给予小剂量右美托咪定镇静,对照组给予咪达唑仑镇静,比较两组谵妄发生率、应激反应水平和不良反应发生率。结果相比于对照组,观察组目标镇静所需时间较长[(16.87±4.13)比(18.56±4.39)min,P=0.038],但谵妄发生率更低(30.36%比10.71%,P=0.010),首次谵妄出现时间更晚[(4.32±1.42)比(5.83±1.32)d,P<0.001],谵妄持续时间更短[(13.41±8.56)比(5.34±3.23)h,P<0.001],停药后唤醒所需时间更短[(59.65±30.82)比(14.76±6.74)min,P<0.001]。在应激反应比较中,观察组第18小时(P=0.001)及第24小时(P<0.001)血清皮质醇浓度明显低于对照组。不良反应比较中,观察组呼吸抑制发生率明显低于对照组(P=0.018),其余差异无统计学意义。结论右美托咪定可以有效降低重症病人应激反应水平,减少谵妄发生,且不良反应更少。
Objective To investigate the effect of small dose of dexmedetomidine on patients′ stress reaction and incidence of delirium in intensive care unit.Methods 112 cases of critically ill patients were collected from October 2015 to June 2016,randomly divided into the study group(56 cases) and the control group(56 cases).All patients were given Fentanyl for analgesia,small dose of Dexmedetomidine were used in the study group and Midazolam was given in the control group for sedation.Incidence of delirium,stress level and the incidence of adverse reactions were compared between two groups.Results Compared with control group,the study group needed more time for goal sedation [(16.87±4.13) vs.(18.56±4.39)min,P=0.038],while the incidence of delirium was lower(30.36% vs. 10.71%,P=0.010),the first appearance of delirium was later [(4.32±1.42) vs.(5.83±1.32) d,P<0.001],duration of delirium was shorter [(13.41±8.56) vs.(5.34±3.23) h,P<0.001],and awake time after drug withdrawal was shorter [(59.65±30.82) vs.(14.76±6.74) min,P<0.001].In stress reaction comparison,the study group showed significantly lower serum cortisol concentration than the control group at 18 h(P=0.001) and 24 h(P<0.001).In adverse reactions comparison,the study group showed significantly lower incidence of respiratory depression than the control group(P=0.018),while the others with no statistical differences.Conclusion Dexmedetomidine can effectively reduce the severe stress level,decrease the incidence of delirium in critical ill patients,and with less adverse reaction.
Objective To investigate the effect of small dose of dexmedetomidine on patients′ stress reaction and incidence of delirium in intensive care unit.Methods 112 cases of critically ill patients were collected from October 2015 to June 2016,randomly divided into the study group(56 cases) and the control group(56 cases).All patients were given Fentanyl for analgesia,small dose of Dexmedetomidine were used in the study group and Midazolam was given in the control group for sedation.Incidence of delirium,stress level and the incidence of adverse reactions were compared between two groups.Results Compared with control group,the study group needed more time for goal sedation [(16.87±4.13) vs.(18.56±4.39)min,P=0.038],while the incidence of delirium was lower(30.36% vs. 10.71%,P=0.010),the first appearance of delirium was later [(4.32±1.42) vs.(5.83±1.32) d,P<0.001],duration of delirium was shorter [(13.41±8.56) vs.(5.34±3.23) h,P<0.001],and awake time after drug withdrawal was shorter [(59.65±30.82) vs.(14.76±6.74) min,P<0.001].In stress reaction comparison,the study group showed significantly lower serum cortisol concentration than the control group at 18 h(P=0.001) and 24 h(P<0.001).In adverse reactions comparison,the study group showed significantly lower incidence of respiratory depression than the control group(P=0.018),while the others with no statistical differences.Conclusion Dexmedetomidine can effectively reduce the severe stress level,decrease the incidence of delirium in critical ill patients,and with less adverse reaction.
引文
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[24] FARGHALY HS,MAHMOUD AM,SATER KA.Effect of dexmedetomidine and cold stress in a rat model of neuropathic pain:Role of interleukin:6 and tumor necrosis factor:alpha[J].Eur J Pharmacol,2016,776:139-145.
[25] farghaly hs,mahmoud am,sater ka,et al.Direct immune:detection of cortisol by chemiresistor graphene oxide sensor[J].Biosensors & bioelectronics,2017,98(3):473-477.
[2] DONATI M,BRANCATO G,GROSSO G,et al.Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty:A CONSORT:prospective,randomized,clinical trial[J].Medicine (Baltimore),2016,95(24):e3791.DOI:10.1097/MD.0000000000003719.
[3] DHINGRA L,AHMED E,SHIN J,et al.Cognitive Effects and Sedation[J].Pain Med,2015,16(Suppl 1):S37-43.
[4] CHEN L,MENG K,SU W,et al.The Effect of Continuous Sedation Therapy on Immunomodulation,Plasma Levels of Antioxidants,and Indicators of Tissue Repair in Post:Burn Sepsis Patients[J].Cell Biochem Biophys,2015,73(2):473-478.
[5] ZHANG X,WANG D,SHI M,et al.Efficacy and Safety of Dexmedetomidine as an Adjuvant in Epidural Analgesia and Anesthesia:A Systematic Review and Meta:analysis of Randomized Controlled Trials[J].Clin Drug Investig,2017,37(4):343-354.
[6] WEERINK MA,STRUYS MM,HANNIVOORT LN,et al.Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J].Clin Pharmacokinet,2017,22(12):238-240.
[7] PIERCE S,BONANNO L,SANVI S.Effectiveness of intrathecal dexmedetomidine as an adjuvant to bupivacaine spinal anesthesia in adult patients undergoing elective surgery:a systematic review protocol[J].JBI Database System Rev Implement Rep,2016,14(10):15-21.
[8] WIATROWSKI R,NORTON C,GIFFEN D.Analgosedation:Improving Patient Outcomes in ICU Sedation and Pain Management[J].Pain Manag Nurs,2016,17(3):204-217.
[9] AITKEN LM,BUCKNALL T,KENT B,et al.Sedation protocols to reduce duration of mechanical ventilation in the ICU:a Cochrane Systematic Review[J].J Adv Nurs,2016,72(2):261-272.
[10] ZALIECKAS J,WELDON C.Sedation and analgesia in the ICU[J].Semin Pediatr Surg,2015,24(1):37-46.
[11] PARK CH,HAN DS,JEONG JY,et al.Outcomes of Propofol Sedation During Emergency Endoscopy Performed for Upper Gastrointestinal Bleeding[J].Dig Dis Sci,2016,61(3):825-834.
[12] PARK HJ,SHIN JY,KIM MH,et al.Increased use in propofol and reported patterns of adverse events among anesthetics in Korea[J].Regul Toxicol Pharmacol,2015,71(3):478-483.
[13] RAJASEKARAN S,HACKBARTH RM,DAVIS AT,et al.The safety of propofol sedation for elective nonintubated esophagogastroduodenoscopy in pediatric patients[J].Pediatr Crit Care Med,2014,15(6):e261-e269.DOI:10.1097/ppc.00000000000000 147.
[14] LI CW,LI YD,TIAN HT,et al.Dexmedetomidine:midazolam versus Sufentanil:midazolam for Awake Fiberoptic Nasotracheal Intubation:A Randomized Double:blind Study[J].Chin Med J (Engl),2015,128(23):3143-3148.
[15] TAE CH,KANG KJ,MIN BH,et al.Paradoxical reaction to midazolam in patients undergoing endoscopy under sedation:Incidence,risk factors and the effect of flumazenil[J].Dig Liver Dis,2014,46(8):710-715.
[16] PAPINENI A,MATHARU L,ASHLEY PF.Safety of oral midazolam sedation use in paediatric dentistry:a review[J].Int J Paediatr Dent,2014,24(1):2-13.
[17] AVRAMESCU S,WANG DS,CHOI S,et al.Preventing delirium:beyond dexmedetomidine[J].Lancet,2017,389(10073):1009.
[18] READE MC.Low dose dexmedetomidine for the prophylaxis of perioperative ICU delirium:how much evidence is enough?[J].J Thorac Dis,2016,8(11):3020-3023.
[19] KNAUERT MP,PISANI MA.Dexmedetomidine for hyperactive delirium:worth further study[J].J Thorac Dis,2016,8(9):E999-E1002.
[20] JIANG YK,WANG S,LAM TS,et al.Prevalence of delirium and coma in mechanically ventilated patients sedated with dexmedetomidine or propofol[J].P T,2016,41(7):442-445.
[21] CARRASCO G,BAEZA N,CABRE L.Dexmedetomidine,agitated delirium,and "off:label" drugs[J].J Thorac Dis,2016,8(10):E1432-E1434.
[22] BECKER SE.A pilot study implementing a protocol using dexmedetomidine as a safe alternative to traditional sedation to decrease ventilator days for patients difficult to extubate[J].Dimens Crit Care Nurs,2016,35(5):291-297.
[23] MCLAUGHLIN M,MARIK PE.Dexmedetomidine and delirium in the ICU[J].Ann Transl Med,2016,4(11):224.
[24] FARGHALY HS,MAHMOUD AM,SATER KA.Effect of dexmedetomidine and cold stress in a rat model of neuropathic pain:Role of interleukin:6 and tumor necrosis factor:alpha[J].Eur J Pharmacol,2016,776:139-145.
[25] farghaly hs,mahmoud am,sater ka,et al.Direct immune:detection of cortisol by chemiresistor graphene oxide sensor[J].Biosensors & bioelectronics,2017,98(3):473-477.