右美托咪啶在ICU重症住院患者中的应用效果及对谵妄发生率的影响
|
摘要
目的探讨右美托咪啶在ICU重症住院患者中的应用效果及对谵妄发生率的影响。方法选取本院2015年7月至2017年12月期间收治的ICU住院患者104例为研究对象。采用随机数字表法将其分为对照组和观察组,各52例。观察组泵入盐酸右美托咪啶注射液进行镇静,对照组泵入咪达唑仑注射液进行镇静,比较两组镇静前后血流指标(HR、SBP、DBP、SpO2)变化、谵妄发生时间及发生率。结果两组患者镇静前HR、SBP、DBP及SpO2等指标比较差异无统计学意义;对照组镇静后SBP、DBP下降(P<0.05),HR及SpO2无变化;观察组镇静后HR下降(P<0.05),SBP、DBP、SpO2无变化;观察组镇静后HR低于对照组,SBP、DBP高于对照组(P<0.05);观察组谵妄发生时间为镇静后(5.88±1.21)h明显迟于对照组(4.35±1.06)h,谵妄发生率(7.69%)明显低于对照组(25.00%),差异有统计学意义(P<0.05)。结论应用右美托咪定镇静时可降低ICU住院患者的心率,但对患者血压及血氧饱和度无明显影响,同时,右美托咪定可推迟患者谵妄发生时间,降低谵妄的发生率,临床应用效果满意。
Objective To investigate the effect of dexmedetomidine on the incidence of delirium in ICU patients. Methods 104 cases of ICU admitted to our hospital from July 2015 to December 2017 were selected as the research subjects. They were divided into control group and observation group by random number table grouping method, 52 cases in each group. The observation group was sedated by dexmedetomidine hydrochloride injection, and the control group was sedated by midazolam injection. The changes of blood flow indexes(HR, SBP, DBP, SpO2) before and after sedation, the occurrence time and incidence of delirium were compared between the two groups. Results There was no significant difference in HR,SBP, DBP and SpO2 between the two groups before sedation; SBP, DBP decreased after sedation in the control group(P<0.05), HR and SpO2 did not change; HR decreased after sedation in the observation group(P<0.05), SBP, DBP, SpO2 did not change; HR in the observation group after sedation was lower than that in the control group. SBP and DBP in the observation group were higher than those in the control group(P<0.05), delirium occurrence time in the observation group was(5.88±1.21) h after sedation was significantly later than that in the control group(4.35±1.06) h, and the incidence of delirium(7.69%) was significantly lower than that in the control group(25.00%)(P<0.05). Conclusion Dexmedetomidine sedation can reduce the heart rate of ICU inpatients, but has no significant effect on blood pressure and oxygen saturation. At the same time, dexmedetomidine can postpone the onset of delirium and reduce the incidence of delirium. The clinical effect is satisfactory.
Objective To investigate the effect of dexmedetomidine on the incidence of delirium in ICU patients. Methods 104 cases of ICU admitted to our hospital from July 2015 to December 2017 were selected as the research subjects. They were divided into control group and observation group by random number table grouping method, 52 cases in each group. The observation group was sedated by dexmedetomidine hydrochloride injection, and the control group was sedated by midazolam injection. The changes of blood flow indexes(HR, SBP, DBP, SpO2) before and after sedation, the occurrence time and incidence of delirium were compared between the two groups. Results There was no significant difference in HR,SBP, DBP and SpO2 between the two groups before sedation; SBP, DBP decreased after sedation in the control group(P<0.05), HR and SpO2 did not change; HR decreased after sedation in the observation group(P<0.05), SBP, DBP, SpO2 did not change; HR in the observation group after sedation was lower than that in the control group. SBP and DBP in the observation group were higher than those in the control group(P<0.05), delirium occurrence time in the observation group was(5.88±1.21) h after sedation was significantly later than that in the control group(4.35±1.06) h, and the incidence of delirium(7.69%) was significantly lower than that in the control group(25.00%)(P<0.05). Conclusion Dexmedetomidine sedation can reduce the heart rate of ICU inpatients, but has no significant effect on blood pressure and oxygen saturation. At the same time, dexmedetomidine can postpone the onset of delirium and reduce the incidence of delirium. The clinical effect is satisfactory.
引文
[1]石潇洋,张文文,徐月清,等.护士参与预防ICU患者谵妄的研究进展[J].中华护理杂志,2016,51(3):336-339.
[2]李凌月,张新春,郝桂兰.ICU谵妄的原因分析和护理干预研究[J].首都食品与医药,2016,23(18):92-93.
[3]杨娜瑜,姜丽华.老年患者术后谵妄的研究进展[J].临床麻醉学杂志,2013,29(10):1039-1040.
[4]吕盼盼,李来传,史有奎,等.右美托咪啶对慢性阻塞性肺疾病急性加重期应用无创呼吸机患者的临床疗效[J].中国现代医药杂志,2016,18(9):24-27.
[5]杨明全,周洁,曹建伟,等.ICU机械通气患者右美托咪定镇静的安全性评价[J].中华危重病急救医学,2016,28(9):839-844.
[6]冯传江,姚琴琴,欧丹丹,等.危重患者谵妄发生的危险因素分析[J].临床麻醉学杂志,2016,32(7):672-675.
[7]杨昆,王雁.急诊危重症患者谵妄发生的危险因素及护理对策[J].护士进修杂志,2016,31(16):1493-1495.
[8]杜航,董晨明.重症医学科患者谵妄预防策略研究进展[J].中华医学杂志,2017,97(25):1995-1998.
[9]孙丹丹.ICU谵妄持续时间及影响因素的研究[D].北京协和医学院,2017.
[10]吕继辉,陈峥,李翔,等.多因素评估和多学科干预防治老年住院患者谵妄的效果评价[J].中华老年医学杂志,2015,34(12):1306-1309.
[11]王晶晶,尹芳,陈君超,等.咪达唑仑、异丙酚与阿芬太尼联合催眠作用的模型化评价[J].中国临床药理学杂志,2016,32(7):646-648.
[12]艾长良,陈晓芳,范学峰.咪达唑仑、丙泊酚、右美托咪定辅助硬膜外麻醉的镇静效果比较[J].当代医学,2015,21(3):129-130.
[13]盖春梅.盐酸右美托咪定的药理分析与临床应用探讨[J].中国医药指南,2017,15(36):121-122.
[2]李凌月,张新春,郝桂兰.ICU谵妄的原因分析和护理干预研究[J].首都食品与医药,2016,23(18):92-93.
[3]杨娜瑜,姜丽华.老年患者术后谵妄的研究进展[J].临床麻醉学杂志,2013,29(10):1039-1040.
[4]吕盼盼,李来传,史有奎,等.右美托咪啶对慢性阻塞性肺疾病急性加重期应用无创呼吸机患者的临床疗效[J].中国现代医药杂志,2016,18(9):24-27.
[5]杨明全,周洁,曹建伟,等.ICU机械通气患者右美托咪定镇静的安全性评价[J].中华危重病急救医学,2016,28(9):839-844.
[6]冯传江,姚琴琴,欧丹丹,等.危重患者谵妄发生的危险因素分析[J].临床麻醉学杂志,2016,32(7):672-675.
[7]杨昆,王雁.急诊危重症患者谵妄发生的危险因素及护理对策[J].护士进修杂志,2016,31(16):1493-1495.
[8]杜航,董晨明.重症医学科患者谵妄预防策略研究进展[J].中华医学杂志,2017,97(25):1995-1998.
[9]孙丹丹.ICU谵妄持续时间及影响因素的研究[D].北京协和医学院,2017.
[10]吕继辉,陈峥,李翔,等.多因素评估和多学科干预防治老年住院患者谵妄的效果评价[J].中华老年医学杂志,2015,34(12):1306-1309.
[11]王晶晶,尹芳,陈君超,等.咪达唑仑、异丙酚与阿芬太尼联合催眠作用的模型化评价[J].中国临床药理学杂志,2016,32(7):646-648.
[12]艾长良,陈晓芳,范学峰.咪达唑仑、丙泊酚、右美托咪定辅助硬膜外麻醉的镇静效果比较[J].当代医学,2015,21(3):129-130.
[13]盖春梅.盐酸右美托咪定的药理分析与临床应用探讨[J].中国医药指南,2017,15(36):121-122.