芬太尼与瑞芬太尼用于ICU机械通气患者的效果比较

Comparison of analgesic effects between fentanyl and remifentanil for mechanically ventilated patients in ICU

目的比较芬太尼与瑞芬太尼用于重症监护病房(ICU)机械通气患者镇痛、镇静治疗的效果。方法 150例术后拟行机械通气患者,按随机数字表法分为芬太尼组及瑞芬太尼组各75例,分别给予芬太尼和瑞芬太尼持续静脉泵入镇痛、镇静。观察两组患者的疼痛视觉模拟(VAS)评分、血流动力学指标及用药后的不良反应。结果两组患者均可达到满意的镇痛、镇静效果。瑞芬太尼组患者在用药后30、60、120 min、脱机后和拔管时的VAS评分均低于芬太尼组,呼吸抑制的人数多于芬太尼组,差异均有统计学意义(P<0.05)。两组患者的血流动力学及不良反应差异无统计学意义(P>0.05)。结论瑞芬太尼用于ICU机械通气患者较芬太尼镇静、镇痛效果更佳,但瑞芬太尼具有相对较高的呼吸抑制。用药后二者的血流动力学和不良反应相当。

Objective To compare the analgesic and sedation effects between fentanyl and remifentanil for mechanically venti -lated patients in intensive care unit （ ICU） .Methods One hundred and fifty patients with invasive mechanical ventilation after opera -tion were randomly allocated to fentanyl group （n =75）and remifentanil group（n =75）.The patients received a persistent infusion of either fentanyl or remifentanil for sedation and analgesia .The level of analgesia was assessed according to VAS .During ICU therapy ,the indexes of the hemodynamics and adverse reaction were recorded .Results The VAS value in the remifentanil group was lower than that in the fentanyl group after administration of 30,60 and 120 min as well as after off-line and extubation while incidence of respiratory inhibition in the remifentanil group was more than that in the fentanyl group .The differences were statistically significant （ P〈0.05 ） . However ,there was no significant difference in hemodynamics and other adverse reactions between the two groups .Conclusion Remifentanil has a better analgesic and sedation effect than fentanyl when used in patients with mechanical ventilation .However , remifentanil has a higher respiratory inhibition effect than fentanyl .The effects of remifentanil on hemodynamics and adverse reaction were similar to fentanyl .