镇静对脑卒中机械通气患者呼吸力学的影响(1)
[摘要] 目的 探讨镇静对脑卒中机械通气患者呼吸力学的影响。 方法 选择2017年1月～2019年12月在我院EICU行机械通气的急性脑卒中患者100例为研究对象，随机分为A组与B组。两组均采用右美托咪定镇静，A组维持RASS在-2～1分，B组维持RASS控制在-3～-2分。比较两组镇静前、镇静后气道峰压(Ppeak)、动態顺应性(Cdny)、潮气量(VT)、动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)，记录两组谵妄发生率、心动过缓发生率、低血压发生率、机械通气时间、EICU住院时间、28 d死亡率。 结果 (1)第5天、第7天A组Ppeak显著低于B组，第3天、第5天、第7天A组Cdny、VT显著高于B组，差异有统计学意义(P<0.05)。(2)两组SaO2、PaO2呈逐渐上升的趋势，PaCO2呈逐渐下降的趋势。第3天、第5天及第7天A组SaO2、PaO2显著高于B组，PaCO2显著低于B组，差异有统计学意义(P<0.05)。(3)A组心动过缓、低血压发生率以及28 d死亡率显著低于B组，机械通气时间、EICU住院时间显著短于B组，差异有统计学意义(P<0.05)。 结论 镇静有利于改善机械通气患者呼吸动力学指标，而轻度镇静效果更好，可缩短机械通气时间、EICU住院时间，并降低低血压、心率过缓等不良反应的发生。
[关键词] 镇静;右美托咪定;脑卒中;机械通气;呼吸力学
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2020)21-0054-04
The effect of sedation on respiratory mechanics in patients with mechanical ventilation after stroke
LIU Jingjing LU Junfeng
Department of Emergency/Department of Neurology， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou 310007， China
[Abstract] Objective To investigate the effect of sedation on respiratory mechanics in patients with mechanical ventilation after stroke. Methods 100 patients with acute stroke who underwent mechanical ventilation in the EICU of our hospital from January 2017 to December 2019 were selected as the study subjects. They were randomly divided into group A and group B. Both groups were sedated with dexmedetomidine. The RASS scores were maintained from -2 to 1 in the group A. The RASS scores were maintained from-3 to-2 points in the group B. The peak airway pressure (Ppeak)， dynamic compliance (Cdny)， tidal volume (VT)， arterial oxygen saturation (SaO2)， arterial blood oxygen partial pressure(PaO2) and carbon dioxide pressure(PaCO2) were compared between two groups before and after sedation. The incidence of delirium， bradycardia and hypotension， mechanical ventilation time， EICU hospital stay， 28 d mortality rate were recorded in both groups. Results (1)The Ppeak of group A was significantly lower than that of group B on day 5 and day 7. The Cdny and VT of Group A were significantly higher than those of group B on day 3， day 5 and day 7， and the difference was statistically significant(P<0.05). (2) SaO2 and PaO2 in the two groups showed a gradual upward trend， and PaCO2 showed a gradual downward trend. On day 3， day 5 and day 7， SaO2 and PaO2 in group A were significantly higher than those in group B， and PaCO2 in group A was significantly lower than that in group B， statistically significant difference(P<0.05). (3)The rate of bradycardia and hypotension， and 28-day mortality in group A were significantly lower than those in group B. The duration of mechanical ventilation and EICU hospital stay in group A were significantly shorter than those in group B(P<0.05). Conclusion Dexmedetomidine is helpful to improve the respiratory dynamics of patients with mechanical ventilation. Mild sedation is better， which can shorten the time of mechanical ventilation， EICU hospital stay， and reduce adverse reactions such as hypotension and bradycardia., http://www.100md.com(刘晶晶 卢军锋)
[关键词] 镇静;右美托咪定;脑卒中;机械通气;呼吸力学
[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701(2020)21-0054-04
The effect of sedation on respiratory mechanics in patients with mechanical ventilation after stroke
LIU Jingjing LU Junfeng
Department of Emergency/Department of Neurology， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou 310007， China
[Abstract] Objective To investigate the effect of sedation on respiratory mechanics in patients with mechanical ventilation after stroke. Methods 100 patients with acute stroke who underwent mechanical ventilation in the EICU of our hospital from January 2017 to December 2019 were selected as the study subjects. They were randomly divided into group A and group B. Both groups were sedated with dexmedetomidine. The RASS scores were maintained from -2 to 1 in the group A. The RASS scores were maintained from-3 to-2 points in the group B. The peak airway pressure (Ppeak)， dynamic compliance (Cdny)， tidal volume (VT)， arterial oxygen saturation (SaO2)， arterial blood oxygen partial pressure(PaO2) and carbon dioxide pressure(PaCO2) were compared between two groups before and after sedation. The incidence of delirium， bradycardia and hypotension， mechanical ventilation time， EICU hospital stay， 28 d mortality rate were recorded in both groups. Results (1)The Ppeak of group A was significantly lower than that of group B on day 5 and day 7. The Cdny and VT of Group A were significantly higher than those of group B on day 3， day 5 and day 7， and the difference was statistically significant(P<0.05). (2) SaO2 and PaO2 in the two groups showed a gradual upward trend， and PaCO2 showed a gradual downward trend. On day 3， day 5 and day 7， SaO2 and PaO2 in group A were significantly higher than those in group B， and PaCO2 in group A was significantly lower than that in group B， statistically significant difference(P<0.05). (3)The rate of bradycardia and hypotension， and 28-day mortality in group A were significantly lower than those in group B. The duration of mechanical ventilation and EICU hospital stay in group A were significantly shorter than those in group B(P<0.05). Conclusion Dexmedetomidine is helpful to improve the respiratory dynamics of patients with mechanical ventilation. Mild sedation is better， which can shorten the time of mechanical ventilation， EICU hospital stay， and reduce adverse reactions such as hypotension and bradycardia., http://www.100md.com(刘晶晶 卢军锋)