舒芬太尼与芬太尼对机械通气患者镇痛的效果比较

Analgesic Effects of Sufentanil and Fentanyl for Patients Undergoing Mechanical Ventilation

目的:比较舒芬太尼与芬太尼对机械通气(MV)患者镇痛的效果。方法:选择我院2012年1月至2014年1月收治的87例手术室MV患者,按随机数字表法分为两组,芬太尼组44例患者应用芬太尼镇痛,舒芬太尼组43例患者应用舒芬太尼镇痛,比较两组患者用药前后心率(HR)、自主呼吸频率(RR)、平均动脉血压(MAP)及脉搏氧饱和度(Sp O2)基本生命指征变化,同时记录两组患者芬太尼、舒芬太尼及咪达唑仑用量,MV时间,持续镇痛时间,手术室滞留时间,比较两组患者用药前后Ramsay评分。结果:1两组用药后1h(T1)及24 h(T2)HR、RR及MAP较用药前(T0)明显下降,Sp O2较T0明显升高,差异有统计学意义(P<0.05);芬太尼组MAP在T1及T2时刻下降程度明显高于舒芬太尼组,差异有统计学意义(P<0.05)。2两组患者在T1时刻Ramsay评分较T0时刻明显升高,且舒芬太尼组升高程度明显高于芬太尼组,差异有统计学意义(P<0.05)。3达到较好镇痛效果水平时,舒芬太尼组患者镇痛药物用量及咪达唑仑用量均明显少于芬太尼组,且舒芬太尼组MV时间及手术室滞留时间明显短于芬太尼组,差异有统计学意义(P<0.05),两组患者持续镇痛时间比较差异无统计学意义(P>0.05)。结论:MV患者使用舒芬太尼的镇痛镇静效果优于芬太尼,可有效节省咪达唑仑的使用量,缩短MV及手术室滞留时间,值得临床推广应用。

Objective： To compare the analgesic effects of sufentanil and fentanyl for patients undergoing mechanical ventilation（MV）. Methods： A total of 87 patients, who were admitted to Dongying District People＇s Hospital for operation from January 2012 to January 2014, were selected and randomly divided into two groups： fentanyl group（n=44） and sufentanil group（n=43）. Then the changes of HR, RR, MAP and Sp O2 of the two groups before and after treatment were compared; at the same time, fentanyl, sufentanil and midazolam dosage, MV time, analgesia duration, and retention time in the operation room of the two groups were recorded, and the Ramsay scores of the two groups before and after treatment were compared. Results： 1Compared with before administration, HR, RR and MAP of the two groups 1 h and 24 h after administration obviously decreased, but Sp O2 increased, and the difference was statistically significant（P〈0.05）. The decreasing degree of MAP in fentanyl group 1 h and 24 h after administration administraion was obviously higher than that in sufentanil group, the difference was statistically significant（P〈0.05）. 2Ramsay scores of the two groups 1 h after administration was significantly higher than before administration, and the increasing degree in the sufentanil group was significantly higher than that in fentanyl group, and the difference was statistically significant（P〈0.05）. 3 When the analgesic effect reached to a good level, the analgesic dosage and midazolam dosage in sufentanil group were obviously less than those in the fentanyl group, and MV time and retention time in the operation room in the sufentanil group were significantly shorter than those in fentanyl group, the difference was statistically significant（P〈0.05）, but there was no difference in analgesia duration of the two groups（P〉0.05）. Conclusion：For patients undergoing MV, the administration of sufentanil has a better analgesia and sedative effect than the administration of fentanyl,which can significantly save the midazolam dosage and shorten the MV time and retention time in the operation room, and is worthy of clinical application.