咪达唑仑联合瑞芬太尼对机械通气重症肺炎患者镇痛镇静效果分析

Analgesic and sedative effect of midazolam combined with remifentanil in patients with severe pneumonia undergoing mechanical ventilation

目的比较咪达唑仑联合瑞芬太尼与丙泊酚联合瑞芬太尼对机械通气重症肺炎患者的镇痛镇静效果及对身体各系统的影响。方法选取2017-10-01-2020-01-31徐州医科大学附属第三医院收治的60例机械通气>24h的重症肺炎患者,根据镇痛镇静方案分为咪达唑仑联合瑞芬太尼组(观察组,n=32)和丙泊酚联合瑞芬太尼组(对照组,n=28);使用疼痛行为量表(BPS)和RASS镇静评分表评估2组患者的镇痛和镇静效果;记录2组患者的机械通气时间和拔管时间;记录同等镇痛和镇静情况下瑞芬太尼的用量;记录患者用药后的不良反应发生率。结果用药10min后,对照组患者动脉压为(81.82±10.22)mm Hg,观察组患者动脉压为(92.83±11.37)mm Hg,t=3.921,P<0.001;其他时间点,2组患者的心率、呼吸频率、血氧饱和度和动脉压差异均无统计学意义,均P>0.05。在达到相同镇静镇痛效果时,观察组瑞芬太尼用量为(6.27±2.15)μg/(kg·h),对照组瑞芬太尼用量为(11.01±3.28)μg/(kg·h),t=-6.698,P<0.001;2组拔管时间差异无统计学意义,P>0.05;观察组的不良反应发生率为40.63%,对照组不良反应发生率为75.00%,差异有统计学意义,χ^(2)=-7.186,P=0.007。结论咪达唑仑联合瑞芬太尼和丙泊酚联合瑞芬太尼均可对机械通气重症肺炎患者均取得较好的镇痛镇静效果;同等的镇痛镇静效果下,观察组需要的瑞芬太尼较少,对消化系统的不良反应较小;在拔管时间上2组相当。

Objective To compare the analgesic and sedative effects of midazolam combined with remifentanil and propofol combined with remifentanil on mechanical ventilation patients with severe pneumonia.Methods From October 1,2017 to January 31,2020,60 cases of severe pneumonia patients with mechanical ventilation>24 hadmitted to the Third Affiliated Hospital of Xuzhou Medical University were selected and divided into midazolam combined with remifentanil group(observation group,n=32)and propofol combined with remifentanil group(control group,n=28)according to the analgesic and sedative scheme;pain behavior scale(BPS)and RAS S sedation scale was used to evaluate the analgesic and sedative effects of the two groups;the mechanical ventilation time and extubation time of the two groups were recorded;the dosage of remifentanil under the same analgesia and sedation conditions was recorded;and the incidence of adverse reactions was recorded.Results After 10 minutes of medication,the blood pressure of the control group was(81.82±10.22)mm Hg,lower than that of the observation group(92.83±11.37)mm Hg(t=3.921,P<0.001).At other time points,there was no significant difference in heart rate,respiratory rate,oxygen saturation and arterial pressure between the two groups(P>0.05),and the sedative and analgesic effect of the two groups was obvious;when the same sedative and analgesic effect was achieved,the dosage of remifentanil in the observation group was(6.27±2.15)μg/(kg·h),lower than that in the control group(11.01±3.28)μg/(kg·h)(t=-6.698,P<0.001).There was no significant difference in extubation time between the two groups(P>0.05);the incidence of adverse reactions in the observation group was lower than that in the control group,and the adverse reactions in the observation group was 40.63%,lower than that in the control group 75.00%(χ^(2)=-7.186,P=0.007).Conclusion Midazolam combined with remifentanil and propofol combined with remifentanil can achieve good analgesic and sedative effect in patients with severe pneumonia under mechanical ventilation;under the same analgesic and sedative effect,remifentanil is less needed in the observation group,and the adverse reactions to the digestive system are small;in the extubation time,the two groups are similar.