右美托咪定对脓毒症机械通气患者炎症的影响
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摘要
目的观察右美托咪定对脓毒症机械通气患者炎症的影响。方法将44例脓毒症机械通气患者按随机数字表法分为观察组和对照组,每组22例。2组均采用舒芬太尼镇痛,观察组采用右美托咪定镇静,对照组采用咪达唑仑镇静,观察终点为使用镇静药物后28d或者患者死亡。比较2组镇静药物使用前及使用后48h血清TNF-α和IL-6水平,观察2组镇静药物使用后28d内患者呼吸机使用情况与死亡情况。结果观察组镇静药物使用后48h血清TNF-α和IL-6水平均显著低于对照组(P<0.05);镇静药物使用后28d内观察组患者呼吸机使用率显著低于对照组(P<0.05),2组病死率比较差异无统计学意义(P>0.05)。结论右美托咪定镇静可减轻脓毒症机械通气患者的炎症反应,减少呼吸机的使用。
Objective To observe the effect of dexmedetomidine on inflammation in sepsis patients undergoing mechanical ventilation.Methods Forty-four sepsis patients receiving mechanical ventilation were randomly given sufentanil combined with either dexmedetomidine(observation group,n=22)or midazolam(control group,n=22)for sedation.The endpoint was 28 days after sedation or death.Serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels were measured before and 48 hours after sedative administration.In addition,the use of respirator and incidence of death were recorded within 28 days after sedative administration.Results Compared with control group,serum TNF-αand IL-6levels at 48 hours after sedative administration and ventilator utilization rate within 28 days after sedative administration obviously decreased in observation group(P<0.05).There was no significant difference in the mortality between the two groups(P>0.05).Conclusion Dexmedetomidine sedation alleviates inflammatory responses and reduces the use of respirator in sepsis patients receiving mechanical ventilation.
Objective To observe the effect of dexmedetomidine on inflammation in sepsis patients undergoing mechanical ventilation.Methods Forty-four sepsis patients receiving mechanical ventilation were randomly given sufentanil combined with either dexmedetomidine(observation group,n=22)or midazolam(control group,n=22)for sedation.The endpoint was 28 days after sedation or death.Serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels were measured before and 48 hours after sedative administration.In addition,the use of respirator and incidence of death were recorded within 28 days after sedative administration.Results Compared with control group,serum TNF-αand IL-6levels at 48 hours after sedative administration and ventilator utilization rate within 28 days after sedative administration obviously decreased in observation group(P<0.05).There was no significant difference in the mortality between the two groups(P>0.05).Conclusion Dexmedetomidine sedation alleviates inflammatory responses and reduces the use of respirator in sepsis patients receiving mechanical ventilation.
引文
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[2]Memis D,Hekimoglu S,Vatan I,et al.Effects of midazolam and dexmedetomidine on inflammatory responses and gastric intramucosal pH to sepsis,in critically ill patients[J].Br J Anaesth,2007,98(4):550-552.
[3]Pandharipande P P,Sanders R D,Girard T D,et al.Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis:an a priori-designed analysis of the MENDS randomized controlled trial[J].Crit Care,2010,14(2):R38.
[4]陈少媚,曾凡杰,叶伟华,等.右美托咪啶在脓毒症ARDS患者机械通气治疗中的应用[J].山东医药,2016,56(2):58-59.
[5]Klimscha W,Tong C,Eisenach J C.Intrathecal alpha 2-adrenergic agonists stimulate acetylcholine and norepinephrine release from the spinal cord dorsal horn in sheep.An in vivo microdialysis study[J].Anesthesiology,1997,87(1):110-116.
[6]Kimura M,Saito S,Obata H.Dexmedetomidine decreases hyperalgesia in neuropathic pain by increasing acetylcholine in the spinal cord[J].Neurosci Lett,2012,529(1):70-74.
[7]Singer M,Deutschman C S,Seymour C W,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[8]Barr J,Fraser G L,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.
[9]中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南[J].中华危重症医学杂志,2018,11(2):90-113.
[10]Taniguchi T,Kurita A,Kobayashi K,et al.Dose-and time-related effects of dexmedetomidine on mortality and inflammatory responses to endotoxin-induced shock in rats[J].JAnesth,2008,22(3):221-228.