Objective It is to observe the influence and the clinical effect of dexmedetomidine and midazolam on immuno-regulation and systemic inflammatory response in patients with acute lung injury. Methods 84 patients with acute lung injury ( ALI)were randomly divided into dexmedetomidine group and midazolam group and treated with corresponding drug. The in-dexes of immunoglobulin( IgG,IgA,IgM),T-lymphocyte subsets( CD4 +,CD8 +,CD4 + /CD8 +)and the level of plasma serum concentrations of TNF-a,IL-6,CRP and PCT in peripheral venous blood were detected before and after treatment in two groups. The clinical effects after treatment for 14 days were observed. Results After treatment of 7 -day,the indexes of immunoglobulin,T-lymphocyte subsets and inflammatory reaction were markedly improved( all P ﹤0. 05 ). There was no significant difference in the indexes of T -lymphocyte subsets and immunoglobulin between tow groups. The level of plasma serum concentrations of TNF-a,IL-6,CRP and PCT in dexmedetomidine group were significantly lower than that in mid-azolam group(all P﹤0. 05). In the midazolam group,the sedation onset time was markedly shorter in the dexmedetomidine group(P﹤0. 05),the incidence of delirium and hypotension markedly higher than that in the dexmedetomidine group(all P﹤0. 05),and the recovery time after stopping medicine were markedly longer than that in the dexmedetomidine group( P ﹤0. 05). There was no significant difference in 7 -day weaning rate and 14-day mortality rate between the two groups(all P﹥0. 05). After treatment of 7 - day,in the midazolam group,the levels of AST and serum Cr were higher than that in the dexmedetomidine group(all P﹤0. 05),14 -day mortality rate markedly lower than that in the dexmedetomidine group(P﹤0. 05),14 -day clinical ventilator associated pneumonia( VAP)rate,medical costs,and ICU stay time were markedly de-creased in dexmedetomidine group(all P﹤0. 05). Conclusion For the mechanical ventilation and sedation care in the early phase of patients with acute lung injury treated in intensive care unit,a strategy of sedation care with dexmedetomidine could also increase immunoregulation,down rugulation systemic inflammatory response activities as well as in improving the clinical outcome.%目的：探讨咪达唑仑与右美托咪定镇静对急性肺损伤患者免疫炎性反应的影响及临床作用。方法将84例急性肺损伤患者随机分为咪达唑仑组与右美托咪定组42例，2组分别给予相应药物镇静。治疗前及治疗后第7天抽取2组患者外周肘静脉血，检测血清T细胞分化亚群（ CD4＋、CD8＋、CD4＋/ CD8＋）、免疫球蛋白指标（ IgG、IgA、IgM ）以及 C 反应蛋白（CRP）、白细胞介素-6（IL-6）、降钙素原（PCT）、肿瘤坏死因子-α（TNF -α）的变化，观察治疗14 d后的临床效果。结果治疗后第7天，2组血清 T 细胞分化亚群、免疫球蛋白与炎性反应指标均较治疗前明显改善（P 均﹤0.05），2组间血清 T 细胞分化亚群、免疫球蛋白指标比较差异无统计学意义，而右美托咪定组 CRP、IL -6、PCT、TNF -α水平均明显低于咪达唑仑组（P均﹤0.05）。咪达唑仑组镇静起效时间明显短于右美托咪定组（P﹤0.05），但低血压、谵妄发生率明显高于右美托咪定组（P均﹤0.05），停药后苏醒时间明显长于右美托咪定组（P﹤0.05）。2组患者7 d脱机率、14 d病死率比较差异均无统计学意义（P均﹥0.05）。治疗后第7天，咪达唑仑组谷草转氨酶、血清肌酐值均显著高于右美托咪定组（P均﹤0.05），14 d脱机率明显低于右美托咪定组（P ﹤0.05），14 d 临床呼吸机相关肺炎（VAP）发生率、住院费用及 ICU住院时间均显著高于右美托咪定组（P均﹤0.05）。结论右美托咪定用于急性肺损伤 ICU 有创机械通气镇静可以调节患者的免疫功能，减轻各脏器炎性损伤，有助于患者临床结局的良好转归。
展开▼
