右美托咪定对机械通气脓毒症患者肝功能的影响OA
Effect of dexmedetomidine on hepatic function in septic patients undergoing mechanical ventilation
目的 探讨右美托咪定主导的镇静方案对机械通气脓毒症患者肝功能及 28 天院内全因病死率的影响,为脓毒症患者的镇静策略优化提供循证依据.方法 选取 2023 年 7 月—2024 年 6 月滨州医学院附属医院EICU收治的88 例机械通气脓毒症患者,采用随机数字表分为观察组(44 例,右美托咪定镇静方案)和对照组(44 例,咪达唑仑镇静方案).比较两组治疗前及治疗后 7 天的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、乳酸(Lac)水平,序贯器官衰竭评分(SOFA)、急性生理与慢性健康评分(APACHEⅡ),以及 28 天院内全因病死率.结果 治疗后 7 天,两组SOFA评分、APACHEⅡ评分均较治疗前显著降低(P<0.05),且观察组改善程度优于对照组(P<0.05);两组ALT、AST、TBIL、Lac水平均较治疗前显著下降(P<0.05),观察组降幅更显著(P<0.05).观察组 28 天院内全因病死率为 9.09%,显著低于对照组的 29.55%(χ2=5.906,P=0.015).结论 右美托咪定主导的镇静方案可显著改善机械通气脓毒症患者的肝功能指标,降低 28 天院内全因病死率,具有多器官功能保护潜力,但其具体作用机制及长期疗效仍需大样本前瞻性研究进一步验证.
Objective To investigate the effects of dexmedetomidine-based sedation protocol on liver function and 28-day all-cause in-hospital mortality in septic patients undergoing mechanical ventilation,so as to provide evidence-based support for optimizing sedation strategies in such patients.Methods A total of 88 septic patients undergoing mechanical ventilation admitted to the Emergency Intensive Care Unit(EICU)of Affiliated Hospital of Binzhou Medical College from July 2023 to June 2024 were enrolled.They were divided into observation group(44 cases,treated with dexmedetomidine sedation proto-col)and control group(44 cases,treated with midazolam sedation protocol)using a random number table.The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),lactic acid(Lac),sequential organ failure assessment(SOFA)scores,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,and 28-day all-cause in-hospital mortality were compared between the two groups before treatment and 7 days after treatment.Re-sults 7 days after treatment,the SOFA scores and APACHE Ⅱ scores in both groups were significantly lower than those before treatment(P<0.05),and the improvement in the observation group was better than that in the control group(P<0.05).The levels of ALT,AST,TBIL,and Lac in both groups decreased significantly compared to those before treatment(P<0.05),with the observation group showing a more significant decrease(P<0.05).The 28-day all-cause in-hospital mortality of the observation group within 28 days was 9.09%,significantly lower than that of the control group(29.55%)(χ2=5.906,P=0.015).Conclusion Dexmedetomidine-based sedation protocol can significantly improve liver function indexes and reduce 28-day all-cause in-hospital mortality in septic patients undergoing mechanical ventilation,and has poten-tial for multi-organ function protection.However,its specific mechanism of action and long-term efficacy still need to be fur-ther verified by large-sample prospective studies.
郭立莎;徐树莹
滨州医学院附属医院急诊科,山东 滨州 256603滨州医学院附属医院急诊科,山东 滨州 256603
医药卫生
脓毒症机械通气右美托咪定肝功能保护病死率
sepsismechanical ventilationdexmedetomidineliver function protectionmortality
《右江医学》 2026 (2)
139-143,5
滨州医学院科技计划项目(BY2021KJ05)
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