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目的观察右美托咪定对重症脓毒血症合并急性肺损伤和肾损伤患者的临床疗效、炎症因子及肝肾损伤的影响。方法将60例重症脓毒血症合并急性肺损伤和肾损伤患者随机分为对照组30例和试验组30例。2组患者均维持常规治疗。对照组使用丙泊酚注射液进行早期镇静治疗;试验组给予右美托咪定注射液1μg·kg~(-1)·h~(-1)进行早期镇静治疗。2组患者治疗时间均为48 h。记录2组患者机械通气时间、重症监护病房(ICU)入住时间及肾替代治疗(CRRT)持续时间。检测2组治疗前后的血清炎症因子水平及肝肾功能指标。结果对照组的ICU入住时间和CRRT持续时间分别为(96.32±13.51),(61.30±9.85)h;试验组分别为(76.18±11.32),(52.93±9.21)h(P<0.01)。治疗后,试验组和对照组的降钙素原分别为(2.05±0.39),(2.43±0.24)ng·L~(-1);C-反应蛋白分别为(56.36±9.94),(79.91±12.55)ng·L~(-1);白细胞介素-6分别为(78.72±11.33),(92.07±12.55)ng·L~(-1);肿瘤坏死因子-α分别为(17.56±4.07),(24.41±4.25)ng·L~(-1),差异均有统计学意义(均P<0.01)。治疗后,试验组和对照组的谷丙转氨酶分别为(21.37±4.73),(30.46±6.44)U·L~(-1);谷草转氨酶分别为(29.61±6.97),(38.60±7.53)g·L~(-1);碱性磷酸分别为(67.27±7.26),(71.75±8.41)U·L~(-1);总胆红素分别为(11.36±2.91),(14.72±2.29)μmol·L~(-1);尿素氮分别为(7.03±2.03),(10.07±3.12)mmol·L~(-1);血清肌酸酐分别为(87.98±10.56),(123.73±11.74)μmol·L~(-1),差异均有统计学意义(均P<0.05)。2组患者治疗过程中均未出现明显的药物不良反应。结论与丙泊酚相比,右美托咪定对症脓毒血症合并急性肺损伤和肾损伤患者有更好的临床疗效,对脏器的保护作用及炎症因子的改善作用更强。
Objective To observe the effect of dexmedetomidine on clinical efficacy, inflammatory factors and liver and kidney injury in patients with severe sepsis with acute lung injury and renal injury. Methods Sixty patients with severe sepsis with acute lung injury and renal injury were randomly divided into control group (30 cases) and experimental group (30 cases). The patients in both groups were treated routinely. The control group was treated with propofol injection for early sedation. The experimental group was given dexmedetomidine injection 1 μg · kg -1 h -1 for early sedation. Two groups of patients were treated for 48 h. The duration of mechanical ventilation, intensive care unit (ICU) stay and renal replacement therapy (CRRT) duration were recorded in 2 groups. Serum levels of inflammatory cytokines and liver and kidney function were measured before and after treatment in two groups. Results The ICU stay and CRRT duration in the control group were (96.32 ± 13.51) and (61.30 ± 9.85) h, respectively. The test group were (76.18 ± 11.32) and (52.93 ± 9.21) h respectively (P <0.01). After treatment, the levels of procalcitonin were (2.05 ± 0.39) and (2.43 ± 0.24) ng · L -1 in the test group and the control group, respectively; the levels of C-reactive protein were (56.36 ± 9.94) and (79.91 ± 12.55) ng · L -1; IL-6 were (78.72 ± 11.33) and (92.07 ± 12.55) ng · L -1, respectively; tumor necrosis factor-α were (17.56 ± 4.07) , (24.41 ± 4.25) ng · L ~ (-1) respectively, all with statistical significance (all P <0.01). After treatment, the alanine aminotransferases in the test group and the control group were (21.37 ± 4.73) and (30.46 ± 6.44) U · L -1, respectively. The levels of aspartate aminotransferase were (29.61 ± 6.97) and (38.60 ± 7.53) g · L -1 and alkaline phosphatase were (67.27 ± 7.26) and (71.75 ± 8.41) U · L -1, respectively; total bilirubin were (11.36 ± 2.91) and (14.72 ± 2.29) (7.03 ± 2.03) and (10.07 ± 3.12) mmol·L -1, respectively. Serum creatinine was (87.98 ± 10.56) and (123.73 ± 11.74) μmol · L ~ (-1), the differences were statistically significant (all P <0.05). No significant adverse drug reactions occurred in the two groups during the course of treatment. Conclusion Compared with propofol, dexmedetomidine symptomatic sepsis with acute lung injury and renal injury in patients with better clinical efficacy, the protection of organs and the role of inflammatory cytokines better.