丙泊酚和瑞芬太尼对术后神志清楚机械通气重症患者器官功能的保护作用

Protective Effects of Propofol and Remifentanil on Organ Functions in Postoperative Conscious Patients Receiving Mechanical Ventilation

目的:研究丙泊酚和瑞芬太尼应用于术后神志清楚机械通气重症患者的镇静和镇痛时对患者器官功能的保护作用。方法:将45例择期行腹部手术的重症患者随机分为A组、B组和C组,每组15例。3组均用微量注射泵持续输注丙泊酚和瑞芬太尼,丙泊酚用量均为2 mg/(kg·h),而A、B、C组瑞芬太尼用量分别为0.05、0.1、0.15μg/(kg·min)。监测各组患者用药前后呼吸、循环参数以及血糖和皮质醇浓度变化,并评价镇静、镇痛效果。结果:给药后,3组患者均达到良好的镇痛、镇静效果(P<0.05),且患者的心率(HR)、平均动脉压(MAP)、呼吸率(RR)和脉搏血氧饱和度(SpO2)均得到显著改善(P<0.05)。结论:对术后神志清楚的机械通气重症患者应用丙泊酚和瑞芬太尼进行镇静镇痛,可降低机体一系列的应激反应,保护患者心肺等器官功能。在丙泊酚剂量不变的情况下,瑞芬太尼以0.1μg/(kg·min)持续静脉输注较为适宜。

Objective：To study the protective effect of propofol and remifentanil on the organ functions in critically ill but conscious patients receiving mechanical ventilation after operation. Methods： A total of 45 cases of patients undergoing selective abdominal surgery were randomly divided into Group A, Group B, Group C, with 15 cases in each group. All patients in the three groups underwent syringe pump infusion of propofol and remifentanil. The dose of propofol was 2 mg/（kg ·h）, but remifentanil dosage were 0.05, 0.1,0.15μg / （kg·min） in Group A, Group B, Group C, respectively. In each group, the respiratory and circulatory parameters, and changes in blood glucose, and cortisol concentrations before and after medications were measured, and the effect of sedation was evaluated. Results： After administration of drugs, all patients in three groups have reached good analgesic and sedative effect（P〈0.05）, and the heart rate （HR）, mean arterial pressure （MAP）, respiratory rate （RR） and arteried oxygen pressure （SpO2） of patients were significantly improved （P〈0. 05）. Conclusions： In postoperative conscious critically ill patients receiving mechanical ventilation, propofol and remifentanil can reduce the body＇s stress response and plays a protective role in functions of heart and lung. With the propofol dose unchanged, remifentanil 0.1μg/（kg·min） continuously intravenous infused is appropriate.