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目的观察右美托咪定在肺性脑病患者使用无创呼吸机时对疗效的影响。方法选取2013年6月-2014年5月收治的52例使用无创呼吸机的慢性阻塞性肺疾病患者作为观察对象,以随机数字法将患者分为观察组(27例)和对照组(25例)。两组患者均同时使用伟康Bi PAP synchrony型无创呼吸机治疗,采用压力支持/控制模式。观察组在治疗期间给予盐酸右美托咪定镇静;对照组在患者有意识障碍时使用四肢约束装置、家人劝阻、头部固定等方法,24 h观察期内不使用任何镇静药物。观察两组患者在动脉血气指标、舒适度评价及无创呼吸机使用依从性方面的区别。结果两组患者在治疗2 h时p H值、动脉血二氧化碳分压(Pa CO2)、动脉血氧分压指标比较差异均无统计学意义(P>0.05),治疗12、24 h后p H值、Pa CO2比较差异有统计学意义(P<0.05),观察组优于对照组。使用无创呼吸机后观察组舒适度维持在较高水平,对照组舒适度明显下降,两组患者舒适度评分比较差异有统计学意义(P<0.05)。观察组患者使用无创呼吸机的依从性良好率(88.89%)优于对照组(56.00%),差异有统计学意义(P<0.05)。结论右美托咪定可改善患者使用无创呼吸机时的舒适度及治疗依从性,从而提高对肺性脑病的临床疗效。
Objective To observe the effect of dexmedetomidine on the efficacy of noninvasive ventilator in patients with pulmonary encephalopathy. Methods Fifty-two patients with chronic obstructive pulmonary disease who were treated with noninvasive ventilator from June 2013 to May 2014 were selected as observation subjects. Patients were divided into observation group (n = 27) and control group (n = 25) by random number method ). Both groups were also treated with Weakon Bi PAP synchrony non-invasive ventilator with pressure support / control mode. The observation group received dexmedetomidine hydrochloride sedation during the treatment period. The control group used limb restraint devices, family members discouragement and head immobilization when patients had unconsciousness. In the 24-h observation period, no sedative drugs were used. The differences of arterial blood gas index, comfort evaluation and non-invasive ventilator compliance were observed between the two groups. Results There was no significant difference in p H value, PaCO 2 and arterial oxygen pressure index between the two groups at 2 h after treatment (P> 0.05). After treatment for 12 h and 24 h, p H Value, PaCO 2 was statistically significant difference (P <0.05), the observation group was better than the control group. After noninvasive ventilator, the comfort of the observation group was maintained at a high level, and the comfort of the control group was significantly decreased. There was significant difference in comfort scores between the two groups (P <0.05). The compliance rate of non-invasive ventilator (88.89%) in observation group was better than that of control group (56.00%), the difference was statistically significant (P <0.05). Conclusion Dexmedetomidine can improve the comfort and treatment compliance of non-invasive ventilator in patients, so as to improve the clinical efficacy of pulmonary encephalopathy.