早期目标导向镇静对使用无创呼吸机AECOPD患者的可行性研究*

Early goal-directed sedation in the treatment of AECOPD patients with NIPPV: a pilot feasibility trial*

摘要:

目的 观察早期目标导向镇静对使用无创呼吸机慢性阻塞性肺疾病急性加重（AECOPD）患者的 治疗效果，及对患者呼吸功能、血压情况、插管率的影响。方法 前瞻性将使用无创呼吸机辅助呼吸的AECOPD患者随机分为两组。EGDS组：入ICU立即使用镇静药物（右美托咪定），1～2?h使患者镇静目标为RASS评分-2～1分；对照组：不使用镇静药物。记录入院前、入院后2和4?h的血气分析pH值、二氧化碳分压（PCO2）、心率（HR）、平均动脉压（MAP）、呼吸频率（RF）、氧合指数（PaO2/FiO2）。对气管插管患者进行多因素Logistic回归分析，筛选气管插管危险因素。结果 两组性别、年龄、体重指数（BMI）、既往住院次数比较，差异无统计学意义（P?>0.05）。①不同时间点间的RF、PCO2有差异（P?<0.05）；②EGDS组与对照组RF有差异（P?<0.05）；③EGDS组与对照组RF变化趋势有差异（P?<0.05），PCO2变化趋势无差异（P?>0.05）。将入院指标进行Logistic回归分析，BMI [OlR=0.570（95% CI：0.363，0.896）]、既往住院次数[OlR=2.256 （95% CI：1.430，3.558）]是气管插管的危险因素。结论 使用右美托咪定进行目标导向镇静，能提高使用无创呼吸机AECOPD患者的治疗效果。既往住院次数多，较低BMI可能提示该患者需要气管插管。

关键词:肺疾病，慢性阻塞性;早期目标导向镇静;无创机械通气

Abstract:

Objective To investigate the possibility of using Early Goal-Directed Sedation (EGDS) in the treatment of AECOPD patients with noninvasive positive pressure ventilation (NIPP) and its effect on the respiratory function, endotracheal intubation rate, blood pressure. Methods Ninety-eight AECOPD patients with NIPPV were enrolled in this prospective study. The patients were randomly divided into the EGDS group (56 cases) and the control group (42 cases). The EGDS group: The sedative drug dexmedetomidine was administered immediately after admission to ICU. Within 1 to 2 hours, the target of sedation was RASS score- 2 to 1 point. The control group: These patients were under the same treatment but without sedative. Oxygenation index, mean arterial pressure (MAP), heart rate (HR), the indicators of the arterial blood gas analysis (pH, PCO2, PO2), previous hospitalization frequency (HF) were recorded before sedation and after sedation 2 hours and 4 hours. Multivariate logistic regression analysis was performed for patients with tracheal intubation. Results Sex, age, previous hospitalization frequency and BMI were no significant difference between the two groups (P?>?0.05). The results of repeated measurements of variance analysis showed that:① The respiratory frequencies at different time points were different (P??0.05). By Logistic regression analysis, BMI [OlR = 0.57, (95% CI: 0.36, 0.89)] and previous hospitalization frequency [OlR=2.256, (95% CI: 143, 3.56)] were independently predicted endotracheal intubation. Conclusions EGDS might be considered as an effective and safe treatment for AECOPD patients with NIPPV. Both the number of hospitalizations and the lower BMI may indicate that the patient needs tracheal intubation.

Key words:pulmonary disease, chronic obstructive; early goal directed sedation; noninvasive mechanical ventilation