外科机械通气危重患者对冬眠合剂的反应性研究

Research on reactivity of critical patients receiving surgical mechanical ventilation to lytic cocktail

目的探讨不同外科机械通气危重患者对冬眠合剂镇痛镇静的反应性。方法选择镇痛镇静需要超过72 h的外科机械通气患者95例,对其临床指标变化进行回顾性分析。结果全组死亡10例(10.51%)。GCS>8分的80例中,达到Riker镇静-躁动评分4分时,严重创伤患者72 h平均用药量(2.20±0.44)ml/h,而脓毒血症休克者(1.23±0.36)ml/h。GCS>8分与GCS≤8分者冬眠合剂用量分别为(2.03±0.54)ml/h和(1.27±0.63)ml/h。有心功能不全患者冬眠合剂用量(1.38±0.45)ml/h,明显低于无心功能不全者[(1.89±0.68)ml/h];有无心功能不全患者72 h内的氧合指数、中心静脉压、LDH变化程度无统计学差异。结论只要严格控制适应证和正确使用,冬眠合剂在外科机械通气重症患者镇痛镇静中应用是安全的。

Objective To study the reactivity of critical patients receiving surgical mechanical ventilation to the analgesia and sedation with lytic cocktail. Methods Ninety five patients who received the surgical mechanical ventilation and needed the analgesia and sedation for more than 72 h were selected, and retrospective analysis was made in the changes in their clinical data. Results Ten cases died（ 10.51% ）. Among the 80 cases whose GCS 〉 8, when the Riker sedation-agitation scale reached 4 points, the average drug consumption of the patients with severe trauma was （ 2.20 _＋ 0.44 ） ml/h, while that of patients with pyemic shock was （ 1.23 ＋_ 0.36） ml/h. In the patients with the GCS 〉 8 or ~〈 8, the usage amount of lyric cocktail was （ 2.03 ＋ 0. 54 ） ml/h and （ 1.27 ＋ 0.63 ）ml/h, respectively. The usage amount of lytic cocktail for patients with cardiac insufficiency was （1.38 -＋ 0.45 ）ml/h which was significantly lower than that for patients without such disease [ （ 1.89 ＋ 0.68 ） ml/h]. There was no significant difference in the changes of oxygenation, central venous pressure, and lactate dehydrogenase within 72 hours among the patients with cardiac insufficiency. Conclusion Lyric cocktail can be used safely to analgesia and sedation in critical patients receiving surgical mechanical ventilation as long as the indication is strictly controlled and the medicine is correctly used.