摘要
目的观察瑞芬太尼对重症监护病房（ICU）机械通气患者镇痛、镇静治疗的效果，对机械通气时间、血流动力学的影响以及药物不良反应。方法60例肿瘤术后需有创机械通气超过24h的患者按随机数字表法分为芬太尼组（30例）及瑞芬太尼组（30例），分别给予芬太尼和瑞芬太尼持续静脉泵入镇痛、镇静，疼痛的评估选择面部表情评分法（FPS），镇静的评估选择Ramsay评分法（RS），必要时加用丙泊酚镇静治疗。两组患者在治疗期间执行每日唤醒策略，分别记录两组用药前后的FPS、RS和生命体征，加用丙泊酚及每日中断药物以唤醒的病例数，机械通气时间、住ICU时间、住ICU费用，以及不良反应发生情况。结果两组患者均可达到满意的镇痛、镇静目标。两组间镇痛、镇静深度总体无明显差异，但用药30min时芬太尼组FPS（分）明显高于瑞芬太尼组（3．70±1．20比2．70±1．17，P〈0．05）；两组间仅用药30min时瑞芬太尼组平均动脉压（MAP，mmHg，1mmHg=0．133kPa）较芬太尼组明显下降（72．9±6．9比77．64±9．1，P〈0．05），其余生命体征无明显差异。芬太尼组有更多的患者需要加用丙泊酚镇静（19例比8例），并需中断药物（12例比4例，均P〈0．05）；而瑞芬太尼组用药30min和1、6、24h时自主呼吸频率（RRs，次／min）均较芬太尼组明显降低（7．0±2．8比10．4±3．5，5．4±3．4比10．6±3．6，5．4±3．0比7．2±3．1，6．1±3．0比9．2±3．4，均P〈0．05）。瑞芬太尼组机械通气时间（h）、住ICU时间（h）均较芬太尼组明显缩短（73．6±26．7比94．9±37-3，125．9±37．1比150．8±50．9，均P〈0．05），但住ICU费用（万元）则无明显差异（6．06±2．29比5．83±2．38，P〉0．05）。瑞芬太尼组出现低血压的患者数比芬太尼组多（8例比2例，P〈0．05）。结论瑞芬太尼用于ICU机械通气患者与经典治疗效果相当，且起效迅速，能缩短机械通气时间，减少镇静剂的用量，无严重不良反应。
Objective To prospectively assess the effect of remifentanil for analgesia and sedation, the impact on sustenance duration of mechanical ventilation and hemodynamics, and also its adverse reaction in the mechanically ventilated patients in the intensive care unit （ICU）. Methods Sixty patients with invasive mechanical ventilation for over 24 hours after tumor operation were randomly allocated to fentanyl group （ n = 30） or remifentanil group （ n = 30 ） to receive a persistent infusion of either fentanyl or remifentanil for sedation and analgesia. The level of analgesia was assessed according to facial pain scale （FPS）, while the level of sedation was assessed according to the Ramsay score （RS）. A propofol infusion was started if additional sedation was necessary. During the therapy, the daily awakening procedure was performed, and the scores of FPS and RS and the vital signs were recorded respectively before and after medication. The number of patients receiving additional propofol infusion, and number of daily interruption of medication and that of daily arousal, the duration of mechanical ventilation, ICU length of stay, and ICU cost were recorded. Furthermore, the incidence of adverse reactions was documented. Results The idea/targets of analgesia and sedation were reached in both groups. There were nearly no significant differences between the groups with respect to the effect of sedation and analgesia. However, the FPS scores in fentanyl group at the 30 minutes of the medication were obviously higher than those of remifentanil group （ 3.70 ± 1.20 vs. 2.70 ± 1.17, P〈 0.05 ）. The mean arterial pressure （ MAP, mm Hg, 1 mm Hg=0.133 kPa） of remifentanil group at 30 minutes was significantly lower than that of fentanyl group （72.9 ± 6.9 vs. 77.6 ± 9.1, P〈0.05 ）. There was no difference between two groups with respect to the other vital signs. More patients in fentanyl group needed the additional propofol infusion （ 19 vs. 8 ） and interruption of medication （ 12 vs. 4, both P〈 0.05 ）. The spontaneous breathing frequency （RRs, bpm） in patients of remifentanil group was lower obviously at 30 minutes and 1, 6, 24 hours than that of fentanyl group （7.0 ± 2.8 vs. 10.4 ± 3.5, 5.4 ± 3.4 vs. 10.6 ± 3.6, 5.4 ± 3.0 vs. 7.2 ± 3.1, 6.1 ± 3.0 vs. 9,2 ± 3.4, all P〈0.05）. The duration of mechanical ventilation （hours） and ICU length of stay （hours） were shortened in remifentanil group compared with fentanyl group （73.6 ± 26.7 vs. 94.9 ± 37.3, 125.9 ± 37.1 vs. 150.8 ± 50.9, both P〈0.05）. With respect to the cost of hospitalization （10 thousand）, no significant difference was found between two groups （6.06 ± 2.29 vs. 5.83 ± 2.38, P〉0.05 ）. The number of patients showing hypotension was much more in remifentanil group than that of fentanyl group （8 vs. 2, P〈0.05 ）. ConclusionsThe effect of remifentanil was similar to that of the conventional therapy. Remifentanil gives rapid effect, shortens the duration of mechanical ventilation, reduces the dosage of propofol, and has no severe adverse effect.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第3期167-170,共4页
Chinese Critical Care Medicine
关键词
瑞芬太尼
镇痛
镇静
机械通气
Remifentanil
Sedation
Analgesia
Mechanical ventilation
