瑞芬太尼与舒芬太尼对重症监护病房老年机械通气患者镇痛和镇静效果比较

Analgesia and sedative effects comparison between remifentanil and sufentanil in olders with ICU mechanical ventilation

目的比较瑞芬太尼与舒芬太尼对重症监护病房(ICU)老年机械通气患者镇痛和镇静效果。方法随机抽取我院ICU需要机械通气的老年患者150例,分为瑞芬太尼组(n=75)和舒芬太尼组(n=75),分别选用瑞芬太尼和舒芬太尼静脉泵入,必要时合并丙泊酚治疗。镇痛评估采用面部表情评分法(FPS),镇静评估选择Ramsay评分法(RS)。对比观察两组患者的FPS、RS评分,生命体征指标,用药情况,机械通气时间,ICU住院时间,ICU住院费用及不良反应发生情况。结果用药30 min,瑞芬太尼组FPS分数低于舒芬太尼组,差异有统计学意义(P<0.05)。用药30 min、1、6、12和24 h瑞芬太尼组自主呼吸频率(RR)均低于舒芬太尼组,差异有统计学意义(P<0.05)。与舒芬太尼组比较,瑞芬太尼组合并用药人数、每日中断用药人数、机械通气时间、ICU住院时间均少于舒芬太尼组,差异有统计学意义(P<0.05)。住院费用和不良反应评价结果,两组差异无统计学意义(P>0.05)。结论瑞芬太尼与舒芬太尼对于ICU老年机械通气患者镇痛和镇静效果明确,且瑞芬太尼具有起效迅速,可缩短机械通气时间,值得临床推广。

Objective To compare the analgesia and sedative effects between remifentanil and sufentanil in olders with ICU mechanical ventilation. Methods One hundred and fifty olders using mechanical ventilation from ICU were involved and divided into remifentanil group （75 cases） and sufentanil group （75 cases）. Patients in the remifentanil group were treated by remifentanil to achieve analgesia sedation, while patients in the sufentanil group were treated by sufentanil. The combination of propofol treatment was used when necessary. The FPS, RS methods were applied in analgesia and sedation evaluation respectively. The FPS, RS score, vital signs index, the drugs, mechanical ventilation time and ICU length of hospital stay, ICU hospitalization expenses and adverse reactions occurred were observed in two groups. Results At the medication for 30 min, the FPS score in the remifentanil group was lower than that in the sufentanil group. The difference was statistically significant （P 〈 0.05）. At the medication for 30 min, 1 h, 6 h, 12 h and 24 h, the RR in remifentanil group was lower than that in the sufentanil group. The difference was statistically significant （P 〈 0.05）. The number of drugs combination, the number of interrupt daily drug, mechanical ventilation time and ICU length of hospital stay in remifentanil group were less than those in sufentanil group. The differences were statistically significant （P 〈 0.05）. There were no statistical difference in terms of hospitalization expense and adverse reactions in both two groups （P 〉 0.05）. Conclusion Both remifentanil and sufentanil used in ICU mechanical ventilation patients have analgesic and sedative effect, but remifentanil＇ s work time is more quick, which can shorten the time of mechanical ventilation.