盐酸丙帕他莫对重症监护病房危重患者镇痛效果及身体依赖性的观察

The analgesic effect and dependence of propacetamol hydrochloride on patients with critical illness in intensive care unit

目的 观察盐酸丙帕他莫对重症监护病房（ICU）危重患者镇痛及身体依赖性的效果.方法 按随机原则将40例ICU重症患者分为盐酸丙帕他莫组（研究组）和芬太尼组（对照组）,每组20例.在患者疼痛难忍时给予镇痛剂,其中对照组静脉输注生理盐水100 ml,15 min 输完,6 h 1次,同时持续泵注芬太尼4 ml/h（10 μg/h）;研究组用盐酸丙帕他莫2 g溶解后稀释于100 ml生理盐水中静脉输注,15 min 输完,6 h 1次,同时持续泵注生理盐水4 ml/h.比较两组镇痛效果,并观察身体依赖性不良反应发生情况.结果 给药后两组均有明显的镇痛作用,且起效快,以对照组更为明显;两组最大镇痛强度时间均在1～72 h.在疼痛强度评价语言尺（PI,级）指标方面显示有较好的一致性,研究组与对照组间比较差异无统计学意义（1 h：2.2±0.7比2.1±0.5,24 h：2.0±0.8比1.9±0.4,48 h：2.1±0.7比1.9±0.5,72 h：2.1±0.6比2.0±0.6,均P〉0.05）;在疼痛缓解评价语言尺（PR）指标方面显示对照组略好于研究组,但组间差异无统计学意义（1 h：4.1±0.5比3.9±0.7,24 h：4.1±0.4比3.8±0.8,48 h：4.2±0.5比3.9±0.7,72 h：4.1±0.6比3.9±0.6,均P〉0.05）.对照组不良反应发生率明显高于研究组[90%（18/20）比5%（1/20）,P〈0.05].结论 盐酸丙帕他莫对ICU危重患者的镇痛安全有效,不良反应发生率低,可作为ICU危重患者镇痛方式的一种选择.

Objective To evaluate the analgesic effect and dependence of propacetamol hydrochloride on patients with critical illness in intensive care unit （ICU）. Methods Forty patients with critical illness who could not tolerate the pain were randomly divided into two groups （each n= 20）： propacetamol hydrochloride group （study group） and fentanyl group （control group）. In the control group, intravenous drip of 100 ml physiological saline was administrated and completed in 15 minutes, once every 6 hours, and in the mean time, persistent 4 ml/h （10 bLg/h） fentanyl venous pump was given. While in the study group, intravenous drip of 2 g propacetamol hydrochloride dissolved in 100 ml physiological saline was administrated and completed in 15 minutes, once every 6 hours, and simultaneously, persistent 4 ml/h physiological saline venous pump was given. The analgesic effect was compared between two groups, and the incidence of adverse effect was observed. Results Both groups had good analgesic effect, and the effect began very fast, being more significant in the control group. The duration of the maximum analgesic effect in the two groups was within 1 - 72 hours. The index on pain intensity （PI） had good consistency. The difference between two groups had no statistical significance （1 hour： 2.2 ± 0. 7 vs. 2.1 ± 0.5, 24 hours ： 2.0 ± 0. 8 vs. 1.9 ± 0. 4, 48 hours ： 2.1±0.7 vs. 1.9±0.5, 72 hours： 2.1±0. 6 vs. 2.0±0.6, all P〈0.05）. The effect of pain relief （PR） on control group was better than that on study group, but there was no statistical significance between the two groups （1 hour： 4.1±0. 5 vs. 3.9±0. 7, 24 hours： 4.1±0.4 vs. 3.8±0.8, 48 hours： 4.2±0.5 vs. 3.9±0. 7, 72 hours：4.1±0. 6 vs. 3.9±0. 6, all P〈0.05）. The incidence of adverse effect in the control group was obviously higher than that of the study group [90% （18/20） vs. 5%（1/20）, P〈0.05]. Conclusion The analgesic action of propacetamol hydrochloride for patients with critical illness in ICU was safe and effective; the incidence of side-effect was low, so it can be chosen as an analgesic drug for patients with critical illness in ICU.