彭伟 怀佳萍

[摘要] 目的 探討老年机械通气患者使用右美托咪定对睡眠和认知功能的影响。 方法 自2018年1月～2019年12月，将我院ICU老年呼吸机患者随机分为右美托咪定组和咪达唑仑组，每组30例。用脑电双频指数监测镇静深度，以多导睡眠检测仪记录睡眠脑电图。记录两组呼吸机使用期间不良反应的发生次数。通过ICU模糊评估方法（CAM-ICU）评估两组患者在7 d内出现谵妄的病例数。使用PSQI和MMSE量表追踪患者3个月的睡眠质量和认知功能状态。 结果 右美托咪定组的睡眠效率显著更高（P<0.05）。7 d内谵妄发生率右美托咪定组较咪达唑仑组患者显著减少（P<0.05）。两组患者在ICU期间发生呼吸抑制不良事件发生率有显著差异（P<0.05），但意外脱管和心血管事件的不良事件发生率无显著差异（P>0.05）。两组在3个月时的MMSE评分有显着差异（P<0.05），但PSQI检查无统计学差异（P>0.05）。 结论 对于有短期机械通气的老年患者，右美托咪定的镇静作用是理想的。

[关键词] 右美托咪定;机械通气;老年人;睡眠;谵妄;认知功能

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2020）18-0114-04

Effect of dexmedetomidine on sleep and cognition in elderly patients with mechanical ventilation

PENG Wei  HUAI Jiaping

Department of Critical Care Medicine， Jinhua Central Hospital of Zhejiang Province， Jinhua   321000， China

[Abstract] Objective To evaluate the effect of dexmedetomidine on sleep and cognitive function in elderly ICU patients with mechanical ventilation. Methods From January 2018 to December 2019， the ICU elderly patients with mechanical ventilation in our hospital were randomLy divided into dexmedetomidine group and midazolam group， with 30 cases in each group. The depth of sedation was monitored with the EEG dual-frequency index， and a shallow sedation state with a BIS value of 65-85 was maintained. The sleep EEG was recorded with polysomnography. The number of adverse events（unexpected detubation events， cardiovascular events， respiratory depression events） during mechanical ventilation of the two groups was recorded. The number of cases of delirium within 7 days in the two groups was evaluated by the ICU fuzzy assessment method（CAM-ICU）. The sleep quality and cognitive function status of patients were followed up for 90 days using Pittsburgh Sleep Quality Index Scale（PSQI） and MMSE Scale. Results The sleep efficiency of the dexmedetomidine group was significantly higher than that of the midazolam group（P<0.05）.The incidence of delirium within 7 days in the dexmedetomidine group was significantly lower than that of the midazolam group（P<0.05）.There was a significant difference in the incidence of respiratory depression adverse events between the two groups during the ICU（P<0.05）. But there was no significant difference in the incidence of adverse events of accidental detubation and cardiovascular events（P>0.05）. The two groups of patients had a significant difference in MMSE score at 3 months of follow-up（P<0.05）. But there was no significant difference in Pittsburgh Sleep Quality Index（PSQI） examination（P>0.05）. Conclusion For elderly patients with short-term mechanical ventilation， the sedative effect of dexmedetomidine is ideal.

[Key words] Dexmedetomidine; Mechanical ventilation; Elderly; Sleep; Delirium; Cognitive function

重症監护病房（ICU）住院的患者一般都病危，他们的身体已经处于临床压力状态。同时，由于侵入性检查和更频繁的护理操作，患者易于产生诸如焦虑和抑郁之类的负面情绪，导致增加的氧气消耗和患者的异常睡眠，从而影响患者身体的恢复，会严重威胁患者的生命。因此，有必要对ICU患者进行及时有效的镇静治疗[1]。特别在机械通气过程中，气管导管具有很大的有害刺激，因此镇静作用非常重要，对治疗效果有重要影响[2]。镇静可以通过某些药物使患者忘记，从而使其处于更舒适的环境中，从而可以减轻患者的焦虑和不安。相关研究证实[3]，既可以轻松唤醒患者，又可以促进患者安静睡眠的镇静作用，可以促进其身体功能的恢复，并起到舒缓患者心理的作用，可以缩短ICU的时间。……