3种药物对ICU患者全身炎症反应综合征的影响

Comparison of the Effect of Propofol, Morphine and Common Analgesics-sedatives on Patients with Systemic Inflammatory Response Syndrome in Intensive Care Unit

目的:比较异丙酚、吗啡或普通镇静剂对于外科重症监护室(SICU)患者全身炎症反应综合征(SIRS)发生率、住SICU时间及机械通气时间的影响。方法:采用前瞻性研究方法。随机将113例住SICU的常规非感染术后患者及急性创伤患者分为3组:A组持续静脉泵入异丙酚加芬太尼;B组持续静脉泵入吗啡;C组间断肌肉注射杜冷丁加安定。每4 h对患者进行Ramsay镇静等级评分,每24 h评价患者符合SIRS的项目。结果:A组、B组发生SIRS的情况与C组比较均有显著差异(P<0．01)．A组与B组发生SIRS的情况无显著差异(P>0．05),A组较B组和C组能够明显缩短机械通气时间(P<0．01)和住SICU时间(P<0．05)。结论:用异丙酚加芬太尼或用吗啡进行有效的长程镇静和镇痛,可明显减低机体的应激反应,降低SIRS的发生率。但用异丙酚较用吗啡和普通镇静、镇痛治疗可明显缩短患者机械通气时间和住SICU的时间,从而有望减少呼吸机相关肺炎及院内感染的发生。

Objective ： To compare the effect of propofol, morphine or traditional analgesics-sedatives on systemic inflammatory response syndrome（SIRS）, time requires for mechanical ventilation and the duration of stay in surgical intensive care unit （SICU）. Methods： 113 non-infected postoperated patients and patients with acute trauma were divided randomly into 3 group. Propofol with fentanyl was used intravenously constantly in group A, morphine was used intravenously constantly in group B, dolantin or diazepam were used intramuscularly intermittently in group C. Results： The occurance rate of SIRS in group A and B showed significant difference comparing to that of group C （P〈0.01）, hut there was no significant difference between group A and B （P〈0. 05）. The time for mechanical ventilation in group A was shorter than in group B and C（P〈0.01 ）, and the duration of stay in SICU was shorter as well. Conclusion： The effective and sedative treatment may reduce pain and anxiety of the patients. The study showed that using propofol and fentanyl of morphine for prolonged sedation will significantly reduce the SIRS effect than using traditional sedative drugs. On the other hand, using propofol for prolonged analgesia will significantly reduce mechanical ventilation time and duration of stay in SICU, this may also reduce the possibility of ventilation related lung infection and nosocominal infection.