贵州医科大学学报

2018, v.43;No.218(11) 1296-1300+1314

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咪达唑仑或丙泊酚联合瑞芬太尼对ICU住院患者镇静镇痛效果
Clinical Comparative Analysis of Sedative Effects Mediated by Remifentanil in Combination with Midazolam or Propofol in ICU Patients

汪颖;王迪芬;刘旭;付江泉;陈先俊;
WANG Ying;WANG Difen;LIU Xu;FU Jiangquan;CHEN Xianjun;Department of Critical Care Medicine,the Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:比较咪达唑仑或丙泊酚分别联合瑞芬太尼对重症医学科(ICU)住院患者的镇静镇痛效果及呼吸、循环、消化系统的影响。方法:72例经口气管插管并行机械通气> 24 h的ICU住院患者,根据镇静镇痛方案分为瑞芬太尼+咪达唑仑组(RM组,n=42)及瑞芬太尼+丙泊酚组(RP组,n=30);采用疼痛行为量表(BPS)评估镇痛效果,RASS镇静评分评估镇静效果;分别记录2组患者用药前(T0),用药10 min(T1)、30 min(T2)、1 h(T3)、6 h(T4)、12 h(T5)及用药24 h(T6)时患者心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、脉搏氧饱和度(SPO2)、中心静脉压(CVP)、BPS评分及RASS评分;记录达到相同镇痛镇静状态下,瑞芬太尼用量;记录2组患者的机械通气时间及从停用呼吸机至拔管时间(拔管时间),比较2组患者用药期间发生低血压、心动过速、心动过缓、呼吸抑制、呕吐、胃肠道返流及便秘的发生率。结果:在用药过程中,RP组MAP在T1时点下降较RM组明显(P <0. 01),2组患者T1时点RASS评分,比较差异有统计学意义(P <0. 01),RP组在T1时点就能达到满意镇静效果,RM组在T2时点才达到满意镇静效果,2组患者均在T1时点就能达到满意镇痛效果,在达到相同镇静、镇痛状态下,RM组单位时间内瑞芬太尼使用量较RP组少(P <0. 01); RM组拔管时间长于RP组(P <0. 05),其余指标比较,差异无统计学意义(P> 0. 05);用药期间,2组患者出现血压下降、呼吸抑制发生率比较,差异无统计学意义(P> 0. 05); RP组患者出现胃返流增多及便秘的比例大于RM组(P <0. 05)。结论:咪达唑仑和丙泊酚分别联合瑞芬太尼均可取得较好的镇痛镇静效果;在相同镇痛镇静效果下,咪达唑仑较丙泊酚单位时间内需要联合瑞芬太尼的用量较少,对消化系统影响小;而丙泊酚的拔管时间较短。
Objective: To compare the dosage of remifentanil combined with midazolam and propofol on sedation and analgesia and their effects on respiration,circulation and digestive system of patients in ICU. Methods: Retrospective analysis of 72 cases of endotracheal intubation and mechanical ventilation for more than 24 hours in ICU. The patients were divided into remifentanil combined with the midazolam(RM) group and the remifentanil combined with propofol(RP) group according to the sedative and analgesic program. The level of analgesia was assessed according to pain behavior scale(BPS),while the level of sedation was assessed according to Richmond Agitation Sedation Scale(RASS). The vital signs,sedative and analgesic effects,the dose of remifentanil,the duration of mechanical ventilation and extubation were recorded. Furthermore,the incidence of adverse reactions was documented.Results: Both groups could reach the satisfactory analgesic level within 10 min(T0),there was no statistic difference(P > 0. 05). Compared with RM group,RP group reached the satisfactory sedative level quickly(P < 0. 01),while to the same analgesic and sedative effect,the dose of remifentanil of RM group was lower than that of RP group in unit time(P < 0. 01). During the therapy,the mean arterial pressure of RP group in 10 minutes(T1) was initially lower than that of RM group(P < 0. 01),while there was no significant difference in vital signs between the two groups in the rest of time(P >0. 05). There was no significant difference between the two groups during mechanical ventilation,adverse reaction on respiratory and circulatory systems. But the duration of extubation in RP group was shorter than that in RM group(P < 0. 05). RP group showed more patients attacked by gastric regurgitation and constipation than RM group(P < 0. 05). Conclusion: Both groups achieved the expected sedative and analgetic effects in the treatment with remifentanil in combination with either midazolam or propofol. Remifentanil combined with midazolam can reduce the dosage of remifentanil,and has less negative influence on digestive system,while remifentanil combined with propofol shows shorter time of extubation than that of midazolam.

关键词(KeyWords): 瑞芬太尼;丙泊酚;咪达唑仑;镇静;镇痛;重症监护;机械通气
remifentanil;propofol;midazolam;sedation;analgesia;intensive care unit;mechanical ventilation

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81701958);; 贵州省高层次人才科研项目(TZJF-2011-25);; 贵州省临床重点学科建设项目(2011-52)

作者(Author): 汪颖;王迪芬;刘旭;付江泉;陈先俊;
WANG Ying;WANG Difen;LIU Xu;FU Jiangquan;CHEN Xianjun;Department of Critical Care Medicine,the Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2018.11.011

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