咪达唑仑联用芬太尼对机械通气患者血浆β-内啡肽及P物质的影响被引量：2

The effects of the levels of serum beta-endorphin and substance P on mechanical ventilated patients with midazolam combined with fentany

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摘要目的观察镇痛镇静药物对机械通气患者血浆β-内啡肽（β-EP）及P物质（SP）表达的影响。方法28例机械通气患者随机分为两组：咪达唑仑组（M组）和咪达唑仑＋芬太尼组（M＋F组），每组各14例；门诊健康体检者8例为对照组（C组）。M组与M＋F验组以注射泵持续静脉内泵入相应镇静药物，并根据疼痛和镇静的效果调节剂量，使患者视觉模拟评分（VAS）≤3分，Ramsay镇静评分2～4分。分别于镇静前，镇静12及24h抽取静脉血3ml，行血浆β-EP及SP测定；记录镇静前，镇静1、12及24h的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏血氧饱和度（SpO2）、吸入氧浓度（FiO2）、气道峰压（Paw）、VAS及Ramsay镇静评分。镇静1、12及24h分别检测1次动脉血氧分压（PaO2），并计算氧合指数（PaO2/FiO2）；镇静达24h时停止药物输注，计算药物总量。结果M组及M＋F组患者镇静前后血浆β-EP及SP含量均明显高于C组（P〈0．05）；M＋F组镇静后sP含量[（101．42±12．46）ng／L]明显低于M组[（132．72±23．82）ng／L]（P〈0．05）。与镇静前比较，M组及M＋F组患者的HR、VAS及Ramsay镇静评分在镇静后各时间点差异均有统计学意义（P〈0．05），MAP在镇静1h、RR在镇静12及24h、Paw在镇静24h均低于镇静前（P〈0．05），PaOJFiO：在镇静24h高于镇静前（P〈0．05）；与M组同时间点比较，M＋F组患者的Paw和RR在镇静12、24h及总体明显降低（P〈0．05）。M＋F组咪达唑仑用量为（493±7．8）μg（kg·h），明显低于M组的（78．2±8．4）μg／（kg·h）（P〈0．05）。结论咪达唑仑联用芬太尼镇痛镇静能够降低机械通气患者血浆sP含量，改善患者的人机顺应性，并减少咪达唑仑用量。 Objective To evaluate the effects of beta-endorphin （ β -EP） and substance P （SP） with sedative and analgesic drugs on mechanical ventilated patients. Methods Twenty-eight mechanical ventilated patients were randomly divided into two groups： midazolam group （M group, 14 cases） and midazolam combined with fentanyl group （M ＋ F group, 14 cases）. Eight healthy persons were as control group （C group）. The sedative target was VAS ≤ 3 scores and Ramsay 2-4 scores. The levels of serum β -EP and SP were tested before sedation and 12, 24 h after sedation in mechanical ventilated patients and at 8 Am in C group. The sedation levels were evaluated and the hemodynamic and respiratory parameters were recorded before sedation and 1, 12, 24 h after sedation in mechanical ventilated patients. The oxygenation index was measured before sedation and 1, 12, 24 h after sedation. Results The levels of serum β -EP and SP in M and M＋F group were significantly higher than those in C group（P 〈 0.05 ）. After sedation, the level of SP in M＋F group [ （ 101.42± 12.46） ng/L]was significantly lower than that in M group [ （ 132.72 ±23.82） ng/L] （P 〈 0.05）. Compared with before sedation, there were significant differences in heart rate, VAS and Ramsay scores between M group and M＋F group （P 〈 0.05 ）. Compared with M group, pressure airway and respiratory rate at 12, 24 h and total after sedation were lower in M＋F group （P 〈 0.05）. The amount of midazolam used in M＋F group [（49.3 ＋7.8）μg/ （kg ·h）]was significantly lower than that in M group [ （78.2 ＋ 8.4） μ g/（kg· h） ] （P 〈 0.05 ）. Conclusions Infusion of midazolam and fentanyl reduce the level of serum SP in mechanical ventilated patients. Fentanyl improves the ventilator synchron and reduces the dose of midazolam.