舒芬太尼在机械通气患者镇痛镇静作用的研究

Effects of sufentanil on analegesia and sedation for mechanically ventilated patients

目的：评价单用或联合应用舒芬太尼在重症监护病房机械通气患者镇痛镇静治疗中的效应和安全性。方法160例ICU需行机械通气患者随机分为四组，分别予舒芬太尼、舒芬太尼联合咪唑安定、舒芬太尼联合右美托咪定、芬太尼镇痛镇静治疗。观察用药前后的面部表情评分法（FPS）、Ramsay评分法（RS）和生命体征的变化，统计比较不同治疗方案对器官功能的影响和不良反应的差异。结果与治疗前相比，四组FPS评分明显下降并维持在3分左右（P＜0．001），RS显著升高（P＜0．001）。在30 min，1 h，6 h时间点，舒芬太尼联合应用咪唑安定或右美托咪定患者RS分值高于单独应用舒芬太尼和芬太尼患者，差异有统计学意义（P＜0．05）。与治疗前相比，四组患者治疗后肺功能指标（PaCO2，血乳酸）、肝功能（AST）、肾功能（肌酐）均降低（P＜0．05）。治疗后芬太尼组呼吸频率高于其他三组，差异有统计学意义（P＜0．05）。联合应用方案舒芬太尼应用总量明显低于单用组（P＜0．05）。四组不良反应发生率差异无统计学意义（P＜0．05）。结论舒芬太尼镇痛镇静效能强，生理干扰小，无严重不良反应，联合用药可显著减少舒芬太尼的用量，并改善其对呼吸的抑制作用，值得推广应用。

Objective To evaluate the effects and security of single or combined sufentanil application on sedation and analgesia for mechanically ventilated patients in intensive care unit（ICU）.Method A total of 160 ICU patients with mechanical ventilation were randomly allocated into four groups：sufentanil group,sufentanil plus midazolam group,sufentanil plus dexmedetomidine group and fentanyl group.Facial pain scale（FPS）,Ramsay score and vital signs were employed to assess the effects of different therapies on organ functions and adverse reactions.Result After the treatment,FPS in all groups were significantly decreased and maintained around 3 points.Ramsay scores were significantly increased（P 〈0.001）and the score in group given sufentanil combined with midazolam or dexmedetomidine at the time points of30 min,1 h,6 h were even higher.Compared with the preoperative data,indicators of lung function（PaCO2and blood lactic acid）,liver function（AST）and renal function（Cr）were decreased in all groups（P 〈0.05）.Respiratory rate in the fentanyl group was significantly higher than the others.Total consumption ofsufentanil in group with combined sufentanil application was significantly lower.No significant differencesin adverse reactions were noticed among the groups（P 〉0.05）.Conclusion For mechanically ventilatedpatients,sufentanil has efficient sedative and analgesic effects with less physiological interference and severe adverse reactions.Combined application is beneficial in decreasing total sufentanil consumption andinhibition to respiratory system,which is worthy of being spread.