国际麻醉学与复苏杂志   2013, Issue (12): 4-4
    
右美托咪啶与吗啡用于慢性阻塞性肺病患者机械通气时对呼吸力学的影响
卢仲谦, 邓义军1()
1.盐城市第一人民医院重症医学科
The effect of dexmedetomidine and morphine for patients with chronic obstructive pulmonary disease during mechanical ventilation on respiratory mechanics
 全文:
摘要：

目的 研究右美托咪定和盐酸吗啡对慢性阻塞性肺病急性发作期（acute exacerbation of chronic obstructive pulmonary disease, AECOPD）行机械通气患者呼吸力学的影响。方法 入选AECOPD伴呼吸衰竭行机械通气患者40例；在同样的分钟通气量和呼气末正压（positive end-expiratory pressure, PEEP）的设置下，随机分为两组，每组20 例，对照组使用吗啡进行镇静治疗，实验组使用盐酸右美托咪定。记录两组患者APACHEⅡ评分、BIS评分、Ramsay 评分等指标。比较两组患者镇静前后生命体征和血气的变化和镇静后呼吸力学参数变化。结果 与对照组相比，实验组中动脉平均血压（mean arterial pressure,MAP）和脉搏（pulse,P）降低（79.6±3.1比74.6±3.5mmHg，91.3±2.4比80.0±3.9次/分；P<0.01）；平均气道压（mean airway pressure, Paw），平台压（plateau pressure, Pplat）明显降低(7.5±0.7比6.2±0.6 cmH2O，19.8±1.7比18.0±1.1 cmH2O;P<0.01)；峰食道压力（peak esophageal pressure, PPEAK ES）、峰食道压力与基准食道压力差（the peak esophageal manometry reference esophagus pressure difference, dPES）变大(-3.4±0.7比-5.4±1.0cmH2O，-6.9±1.0比-9.8±1.3cmH2O;P<0.01)、吸气末屛气期间的跨肺压（folding Screen the end of the suction gas during transpulmonary pressure, Ptp Plat）、肺静态顺应性（pulmonary static compliance, Cst）不变(25.5±2.3比26.0±2.6cmH2O，20.51±1.9比20.13±1.2cmH2O; P>0.05)；气道阻力（airway resistance, Raw）变小(20.30±0.86比15.60±1.39 cm H20/L/sec; P<0.01)；患者呼吸功（patient work of breathing, WOBp）明显增加(0.11±0.02比0.16±0.04 j/L; P<0.01)、机械呼吸功（mechanical work of breathing,WOBv）明显降低(0.49±0.10比0.43±0.06 j/L; P<0.05)。机械通气时间、ICU入住时间减少(76.35±4.67比64.40±3.36h，6.00±1.52比4.65±0.88d; P<0.05)。结论 对机械通气的患者盐酸右美托咪定能提高镇静效果，降低气道阻力，提高肺顺应性，有利于实施保护性通气策略，同时降低呼吸负荷和呼吸做功，因而能降低呼吸氧耗。
关键词： 右美托咪定;慢性阻塞性肺病;机械通气;呼吸力学
Abstract:

Objective：To study effect dexmedetomidine and morphine hydrochloride on respiratory mechanics in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)undergoing mechanical ventilation. Methods：40 cases of AECOPD with respiratory failure undergoing mechanically ventilated patients. They were randomly divided into two groups(n=20) in the same conditions.The control group used Morphine for sedation and the experimental group with dexmedetomidine. APACHE Ⅱ score, the BIS score, ramsay score were recorded. Respiratory mechanical parameters were compared after sedation, and changes in vital signs and blood gas before and after sedation. Results：Compared with the control group, MAP and P were reduced after sedation（79.6±3.1VS 74.6±3.5mmHg，91.3±2.4VS 80.0±3.9B/m；P<0.01）；the Paw and Pplat were significantly down-regulated in experimental group (7.5±0.7 VS 6.2±0.6cmH2O; 19.8±1.7 VS 18.0±1.1cmH2O;P<0.05)；PPEAK ES and dPES was increased (-3.4±0.7VS-5.4±1.0cmH2O;-6.9±1.0VS -9.8±1.3cmH2O;P<0．05); There were no differences between Ptp Plat and Cst (25.5±2.3VS26.0±2.6cmH2O; 20.51±1.9VS 20.13±1.2cmH2O;P>0.05); the Raw) (20.30±0.86 VS 15.60±1.39H20/L/sec;P<0.05) and the mechanical work of breathing (WOBv) (0.49±0.10 VS 0.43±0.06j/L;P<0.05)was increased；The work of breathing (WOBp) was significantly increased(0.11±0.02 VS 0.16±0.04j/L; P<0.05); The time of mechanical ventilation and the ICU stay time were reduced (76.35±4.67 VS64.40±3.36h; 6.00±1.52VS4.65±0.88d;P<0.05). Conclusions：The dexmedetomidine increased the sedative effect and lung compliance, and decreased airway resistance in patients undergoing mechanical ventilation.The dexmedetomidin would also unload respiratory muscle oxygen consumption estimated by reducing the inspiratory load and work of breathing.
Key words: dexmedetomidine，chronic obstructive pulmonary disease，mechanical ventilation，respiratory mechanics