瑞芬太尼在ICU机械通气患者中的应用研究

Application research of remifentanil in patients with mechanical ventilation in ICU

目的观察瑞芬太尼对重症监护病房(ICU)机械通气患者镇痛镇静的治疗效果及安全性。方法 90例行机械通气的ICU患者分为两组,每组45例,分别给予芬太尼和瑞芬太尼持续静脉泵入。疼痛的评估选择面部表情评分(FPS),镇静的评估选择Richmond镇静躁动评分(RASS),必要时加用丙泊酚镇静治疗。比较两组患者在治疗期间的FPS、RASS和生命体征,观察两组的平均起效时间,达到镇痛镇静目标时间,加用丙泊酚的病例数及用量,以及机械通气时间,ICU住院时间和不良反应发生情况。结果瑞芬太尼在应用5min后FPS评分明显降低(P<0.05),而芬太尼则应用10min后FPS评分明显降低;瑞芬太尼达到镇痛目标时间(5.00±1.37)min,芬太尼达到镇痛目标时间(30.00±4.50)min;瑞芬太尼组仅28.9%的患者需合并使用丙泊酚,而芬太尼组则为64.4%(P<0.01);瑞芬太尼组使用丙泊酚用量较芬太尼组低;两组患者用药后各时间点中心静脉压(CVP)、心率(HR)差异均无统计学意义(P>0.05)。与芬太尼组相比,瑞芬太尼组机械通气时间(P<0.05)、ICU住院时间(P<0.05)均较芬太尼组明显缩短。结论瑞芬太尼用于ICU机械通气患者治疗时起效快、镇痛作用强、合并镇静药物用量少,可缩短机械通气与ICU住院时间,无明显不良反应。

Objective To observe the efficacy and safety of remifentanil in patients with mechanical ventilation in Intensive Care Unit（ICU）.Methods Totally 90 cases were enrolled,patients with mechanical ventilation were randomly divided into two groups（remifentanil vs.fentanyl）,45 cases in each group.We used facial expression score（FPS）to monitoring pain,richmond sedation agitation score（RASS）was the sedation tool for measuring quality and depth of sedation.Propofol wase used for sedation therapy.We recorded the data including FPS and RASS and vital signs during the treatment.The primary outcome was the time to reach the goal of analgesia sedation,cases of using propofol and doses of propofol.The secondory outcome was mechanical ventilation time,ICU length of stay and adverse events.Results Fentanyl and remifentanil all could achieve the desired analgesic effect.Compared with fentanyl group,FPS scores showed significantly decreased after 5 min application of remifentanil（P〈0.05）,but FPS scores showed significantly decreased after 10 min application of fentanyl.Analgesia goal time of the remifentanil and fentanyl were（5.00±1.37）min and（30.00±4.50）min,respectively.Only 28.9% of the patients should be combined use of propofol in remifentanil group,but fentanyl group was 64.4%（P〈0.01）;the dosage of propofol of remifentanil group was lower than those of fentanyl group;there was no significant difference in central venous pressure（CVP）and heart rate（HR）between the two groups at each time point（P〈0.05）.The mechanical ventilation time,ICU length of stay in the patients with remifentanil were significantly shorter（P〈0.05）,and adverse events occur less（all P〈0.05）.Conclusion Remifentanil analgesia in patients mechanical ventilated patients is fast onset of action,analgesic effect significantly,with less sedative drug dosage.It also can shorten mechanical ventilation time,ICU length of stay and has no obvious side effects.