镇痛镇静在胸腹部手术后机械通气中的应用

Application of sedative and antalgic treatment in thoracic or abdominal postoperative patients during mechanical ventilation

目的分析芬太尼合并咪达唑仑在胸腹部手术后呼衰患者机械通气的镇痛镇静效果和对血流动力学及呼吸的影响。方法选取我院2006年1月-2007年12月期间胸腹部手术后因呼吸衰竭进行机械通气的患者42例,随机分为两组,A组22例,联合应用芬太尼和咪达唑仑,B组20例,单独应用咪达唑仑。根据镇痛镇静效果调整剂量,使FPS<4分,Ramsay评分2—3分,观察镇痛镇静效果和呼吸循环指标的变化。结果42例患者在负荷剂量下,均很快达到镇痛镇静要求,有效率达100%,维持量也能保持满意的镇痛镇静效果,有效率100%;Ramsay评分在负荷量用药10min即有统计学意义(P<0.05);心率、呼吸频率下降,收缩压和平均动脉压在达到镇静后有所下降,在药物维持阶段趋于平稳。患者均保留了自主呼吸和咳嗽排痰功能,与呼吸机同步性增加,用药1h后平均气道压和气道峰压均有所下降(P<0.05)。结论芬太尼合并咪达唑仑对胸腹部手术后呼衰需机械通气的患者具有良好的镇痛镇静作用,起效快且安全。

Objective To evaluate sedative and antalgic effect of fentanyl and midazalan on thoracic or abdominal postoperative patients during mechanical ventilation. Methods From Jan.2006 to Dec.2007,42 eases of thoracic or abdominal postoperative patients who needed mechanical ventilation were divided into 2 groups randomly.Group A was treated by fentanyl and midazolan,group B was treated by midazolan only.To grade the sedative effect by ramsay＇s gradation and maintain ideal sedative profundity to grade 2-3,to grade the antalgic effect by faces pain scale and maintain ideal antalgic profundity to less than 4, the respiratory and hemodynamic parameters were detected during the treatment. Results All the patients got an exeellent sedative and antalgic situation after 10mins of load quantity medication. Maintenance dosage also achieved satisfactory effect. Ramsay＇s gradation in both increased from 1 to 2-3 after 10mins of the drug administer, showing significant difference （p〈0.05）. Heart beat and breath rate decreased, the systolic blood pressure and mean blood pressure slightly decreased after achieving sedation and kept stable during maintenance. The patients breathed, coughed and brought up the sputum spontaneously. Better coordination between patient＇s breath and ventilater could be observed. Peak inspiratory pressure was lower after 1h of the load （P〈0.05）. Compared to group B, the dosage of midazolan in group A was less （P〈0.05）. Conclusion The use of fentanyl and midazolan can make good sedative and antalgic effect on thoracic or abdominal postoperative patients during mechanical ventilation.