以瑞芬太尼镇痛为基础镇静对ICU机械通气患者血糖波动的影响

Effect of Sedation Based on Remifentanil Analgesia on Blood Glucose Fluctuation in Patients with ICU Mechanical Ventilation

目的观察以瑞芬太尼镇痛为基础的镇静对重症监护病房(ICU)机械通气患者血糖波动的影响。方法 65例ICU需有创机械通气超过72 h的患者随机分为瑞芬太尼组(30例)及芬太尼组(35例),分别给予瑞芬太尼和芬太尼持续静脉泵入镇痛,初始用右美托咪定镇静,如未达到镇静目标加用丙泊酚镇静治疗,比较两组血糖标准差(Glu SD)、血糖不稳定指数(GLI)、平均绝对血糖改变值(MAG)、机械通气时间、住ICU时间及费用、呼吸机相关肺炎(VAP)、28 d存活率。结果两组24 h血糖标准差(Glu SD)、血糖不稳定指数(GLI)、平均绝对血糖改变值(MAG)、住ICU费用、械通气时间、住ICU时间、右美托咪定用量无统计学差异(P> 0.05);72 h瑞芬太尼组Glu SD、GLI、MAG明显低于芬太尼组(P <0.05);瑞芬太尼组丙泊酚用量、VAP发生率明显少于芬太尼组(P <0.05),28d存活率两组无统计学差异(P> 0.05)。结论以瑞芬太尼镇痛为基础的镇静可以减少ICU机械通气患者血糖的波动。

Objective To observe the effect of sedation based on remifentanil analgesia on blood glucose fluctuation in patients undergoing mechanical ventilation in intensive care unit（ICU）. Methods 65 patients with invasive mechanical ventilation support for more than 24 hours in ICU were randomly divided into remifentanil continuous intravenous analgesia group（n=30） and fentanyl continuous intravenous analgesia group（n=35）. The initial target-controlled infusion of dexmedetomidine for sedation was not up to standard to conbined with propofol for sedation. Glucose standard deviation（Glu SD）, glycemic instability index（GLI）, mean absolute glycemic change（MAG）, mechanical ventilation time, ICU stay time and cost, ventilator-associated pneumonia（VAP）, 28 days survival rate were compared between the two groups. Results Two groups of 24 hours Glu SD, GLI, MAG, live ICU expense（ten thousand yuan）, mechanical ventilation time, live ICU time, there was no significant difference in dexmedetomidine dosage（P〉0.05）; Glu SD, GLI, and MAG were significantly lower in the 72 hours remifentanil group than in the fentanyl group（P〈0.05）; the doses of phenols in Remifentanil group and VAP were significantly lower than those in fentanyl（P〈0.05）. The 28 days survival rate was not statistically different between the two groups（P〉0.05）. Conclusion Sedation based on remifentanil analgesia can reduce blood glucose fluctuations in ICU mechanical ventilation patients.