吴萌 王平

摘   要：目的  探討右美托咪啶用于老年重症肺炎有创机械通气患者镇静中的效果及安全性。方法  选取2016年1月～2017年6月需呼吸机辅助呼吸的ICU老年重症肺炎患者40例，通过随机数字表法分为观察组及对照组，每组20例。在常规治疗的基础上，观察组以右美托咪定治疗，对照组以咪达唑仑镇静治疗，观察两组患者达到理想镇静状态所需时间、谵妄发生率、心血管不良事件发生率、ICU驻留时间等指标。结果  观察组达到理想镇静状态所需时间、血压及心率下降率与对照组比较，差异无统计学意义（P>0.05）;观察组患者谵妄发生率为5.00%及ICU驻留时间为（187.89±15.86）h，均低于对照组15.00%、（235.56±16.42）h，差异有统计学意义（P<0.05）。结论  与对照组比较，在老年重症肺炎有创机械通气患者中使用右美托咪啶可以有效降低患者谵妄发生率，缩短患者的ICU驻留时间，进一步改善预后。

关键词：老年重症肺炎;机械通气;右美托咪啶;镇静;谵妄

中图分类号： R614                                   文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2018.16.036

文章编号：1006-1959（2018）16-0118-03

Effect of Dexmedetomidine on Sedation in Elderly Patients with Severe Pneumonia Undergoing Invasive Mechanical Ventilation

WU Meng，WANG Ping

（Department of Critical Care Medicine，Chengdu Fifth People's Hospital，Chengdu 611130，Sichuan，China）

Abstract：Objective  To investigate the efficacy and safety of dexmedetomidine in sedation of elderly patients with severe pneumonia undergoing invasive mechanical ventilation.Methods  40 patients with severe pneumonia in the ICU who needed ventilator-assisted breathing from January 2016 to June 2017 were enrolled.The patients were divided into observation group and control group by random number table，20 cases in each group.On the basis of conventional treatment，the observation group was treated with dexmedetomidine，and the control group was treated with midazolam sedation.The time required for the two groups to achieve ideal sedation，the incidence of sputum， the incidence of cardiovascular adverse events，indicators such as ICU dwell time.Results  There was no significant difference in the time，blood pressure and heart rate between the observation group and the control group（P>0.05）. The incidence of sputum was 5.00% and the ICU stay time was（187.89±15.86）h was lower than the control group 15.00%，（235.56±16.42）h，the difference was statistically significant（P<0.05）.Conclusion  Compared with the control group， the use of dexmedetomidine in elderly patients with severe pneumonia invasive mechanical ventilation can effectively reduce the incidence of delirium，shorten the ICU residence time，and further improve the prognosis.

Key words：Severe pneumonia in the elderly;Mechanical ventilation;Dexmedetomidine;Sedation;Delirium

随着人口老龄化及细菌耐药性的增加，重症肺炎已成为威胁老年人生命健康的主要疾病之一。由于老年患者常多病共存，肺通气功能差，采用机械通气来纠正低氧血症是老年重症肺炎患者常用且行之有效的治疗方法[1]。但也有研究表明，由于患者焦虑、恐惧、炎症反应等多种因素影响，机械通气患者的谵妄发病率可高至70%～80%。谵妄可显著延长患者的低功能状态，进而增加患者的住院时间，影响预后。传统镇静药物大都存在诱发谵妄的风险，而这种风险在老年患者中甚为明显。目前临床上尚未发现理想的镇静镇痛药物。近年来，右美托咪啶已广泛应用于ICU患者的镇静治疗，但在老年重症肺炎患者中的应用临床报道较少。本……