右美托咪定对重症监护病房插管患者血流动力学、血浆儿茶酚胺水平及谵妄发生率的影响——一项随机对照试验

Impact of Dexmedetomidine on Hemodynamics, Plasma Catecholamine Levels, and Delirium Incidence Among Intubated Patients in the ICU--A Randomized Controlled Trial.

作者信息

Qiao Li, Wang Zheng, Shen Jian, Xing Xiaohui, Yuan Hongxun

机构信息

Department of Intensive Care Unit, Peking University International Hospital, Beijing, People's Republic of China.

出版信息

Ther Clin Risk Manag. 2024 Sep 30;20:689-700. doi: 10.2147/TCRM.S471229. eCollection 2024.

DOI:10.2147/TCRM.S471229

PMID:39372263

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11451452/

Abstract

OBJECTIVE

To investigate the impact of various sedative medications on hemodynamics and plasma levels of epinephrine (E) and norepinephrine (NE) in mechanically ventilated patients postoperatively in the intensive care unit (ICU).

METHODS

Ninety-seven patients admitted to the ICU undergoing postoperative mechanical ventilation with tracheal intubation and continuous analgesic sedation following general anesthesia were randomly assigned to either the observation group (dexmedetomidine) (n = 49) or the control group (propofol) (n = 48) in this randomized controlled trial. Upon transfer to the ICU, vital signs (heart rate [HR], respiratory rate [RR], mean arterial pressure [MAP]) were recorded prior to the initiation of the sedation treatment (T0), at one-hour post sedation (T1) and two hours following tracheal extubation (T2), plasma levels of epinephrine (E) and norepinephrine (NE) were measured at these time points. The incidence of delirium was recorded in both groups.

RESULTS

MAP between the two groups at both T0 and T1 At T2 plasma NE and HR were found to be lower in the observation group compared to the control group ( < 0.001). Among the patients receiving antihypertensive medication in the ICU, NE levels were significantly lower in the observation group compared to the control group () Among the patients not receiving antihypertensive medication, both NE (P < ) and MAP (P = ) levels were lower in the observation group compared to the control group. The incidence of delirium in the observation group (dexmedetomidine) was not significantly different from that in the control group (propofol).

CONCLUSION

With dexmedetomidine sedation, blood pressure fluctuated less, plasma catecholamine levels were lower, and sympathetic inhibition was stronger in patients before and after extubation. However, it did not significantly reduce the incidence of postoperative delirium.

摘要

目的

探讨不同镇静药物对重症监护病房（ICU）术后机械通气患者血流动力学及血浆肾上腺素（E）和去甲肾上腺素（NE）水平的影响。

方法

在这项随机对照试验中，97例入住ICU的患者在全身麻醉后接受气管插管和持续镇痛镇静的术后机械通气，被随机分为观察组（右美托咪定）（n = 49）或对照组（丙泊酚）（n = 48）。转入ICU后，在镇静治疗开始前（T0）、镇静后1小时（T1）和气管拔管后2小时（T2）记录生命体征（心率[HR]、呼吸频率[RR]、平均动脉压[MAP]），并在这些时间点测量血浆肾上腺素（E）和去甲肾上腺素（NE）水平。记录两组谵妄的发生率。

结果

两组在T0和T1时的MAP，在T2时观察组的血浆NE和HR低于对照组（<0.001）。在ICU接受抗高血压药物治疗的患者中，观察组的NE水平显著低于对照组（）。在未接受抗高血压药物治疗的患者中，观察组的NE（P < ）和MAP（P = ）水平均低于对照组。观察组（右美托咪定）的谵妄发生率与对照组（丙泊酚）无显著差异。