异丙酚、吗啡或普通镇静剂对重症监护病房患者全身炎症反应综合征影响的比较

Comparison of the Effect of Propofol, Morphine and Common Analgesics-sedatives on Patients with Systemic Inflammatory Response Syndrome in Intensive Care Unit.

目的 :比较异丙酚、吗啡或普通镇静药对于外科重症监护病房 (SICU)患者全身炎症反应综合征 (SIRS)、机械通气时间及住外科ICU时间的影响。方法 :采用前瞻性的研究方法。随机将 113例住SICU的常规非感染术后患者及急性创伤患者分为三组 ,A组使用异丙酚加芬太尼持续静脉泵入 ;B组使用吗啡持续静脉泵入 ;C组使用杜冷丁加安定间断肌肉注射。每 4h对患者进行Ram say镇静等级评分 ,每2 4h评价患者满足SIRS的项目。结果 :A组、B组分别与C组发生SIRS的情况有明显统计学差异 (P <0 .0 1) ,A组与B组发生SIRS的情况无明显统计学差异 (P >0 .0 5 ) ,A组较B组和C组能够明显缩短机械通气时间 (P <0 .0 1) ,减少住SICU时间 (P <0 .0 5 )。结论 :使用异丙酚加芬太尼或使用吗啡进行有效的ICU长程镇静和镇痛 ,可以明显减低机体对打击的应激反应 ,减少SIRS发生率。但使用异丙酚可以较吗啡和普通镇静、镇痛治疗明显缩短患者上机时间 ,减少患者住SICU的时间 ,从而有望减少呼吸机相关肺炎及院内感染的发生。

Objective: To compare the effect of propofol, morphine or traditional analgesics-sedatives on systemic inflammatory response syndrome (SIRS), time requires for mechanical ventilation and the duration of stay in surgical intensive care unit (SICU). Methods: 113 non-infected postoperated patients and patients with acute trauma were divided randomly into 3 groups. Propofol with fentanyl was used intravenously constantly in group A, morphine was used intravenously constantly in group B, dolantin or diazepam were used intramuscularly intermittently in group C. Ramsay sedation scale was evaluated every 4 hours, and SIRS items was evaluated every 24 hours. Results: The state of being develop SIRS in group A and B showed significant difference comparing to that of group C ( P < 0.01), but there is no significant difference between group A and group B ( P < 0.05). The time for mechanical ventilation in group A was shorter than that in group B and C ( P < 0.01), and the duration of stay in SICU was shorter as well. Conclusion: The effective analgesic and sedative treatment may reduce pain and anxiety of the patients. The study showed that using propofol and fentanyl or morphine for prolonged sedation will significantly reduce the SIRS effect than using traditional sedative drugs. On the other hand, using propofol for prolonged analgesia will significantly reduce patient's time of mechanical ventilation and duration of stay in SICU, this may also reduce the possibility to acquire ventilation related lung infection and nosocominal infection.