以瑞芬太尼镇痛为基础的浅镇静对脓毒症心肌病的疗效分析

Effect of light sedation based on remifentanil analgesia on the septic cardiomyopathy patients

目的观察以瑞芬太尼镇痛为基础的浅镇静方案对脓毒症心肌病患者的疗效。方法选取2017年6月1日—2017年12月31日南华大学附属第一医院中心ICU收治的脓毒症心肌病患者44例作为研究对象。按照不同的镇痛方案分成芬太尼组和瑞芬太尼组,且两组患者均采用以右美托咪定为基础的浅镇静。比较两组患者第1和3天血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、心肌肌钙蛋白T(cTnT)、N末端脑钠肽(NT-proBNP)、急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)、脓毒症相关性器官功能衰竭评价(SOFA)和ICU停留时间。结果入ICU第1天患者血清CRP、IL-6与c TnT呈正相关(r=0.682和0.613,P=0.001和0.000)。瑞芬太尼组患者血清CRP、IL-6、cTnT和NT-proBNP低于芬太尼组患者,且下降幅度更大(P<0.05)。在入ICU第3天,瑞芬太尼组患者APACHEⅡ评分和SOFA评分低于芬太尼组(P<0.05);瑞芬太尼组患者和芬太尼组患者ICU停留时间分别为(5.5±2.3)和(8.3±4.6)d,两组比较,差异有统计学意义(P<0.05)。结论以瑞芬太尼镇痛为基础的浅镇静可减轻脓毒症心肌病患者炎症反应,减轻心肌损伤,改善病情及缩短ICU停留时间。

Objective To observe the effect of light sedation based on remifentanil analgesia on the septic cardiomyopathy patients.Methods The present study was a single center retrospective cohort study.The septic cardiomyopathy patients administered into the central intensive care unit(ICU)were divided into the fentanyl group and the remifentanil group according to different analgesic strategy.The patients in the two groups were treated with dexmedetomidine based on light sedation(RASS score from-2 to+1).The parameters in the first day and the third day after administed into ICU,including serum C reactive protein(CRP),interleukin-6(IL-6),cardiac troponin T(cTnT),N-terminal pro-brain natriuretic peptide(NT-proBNP),acute physiology and chronic health evaluation II(APACHE-II),sequential organ failure assessment(SOFA)and ICU stay time,were compared between the two groups.Results There was a significant positive correlation between cTnT,serum CRP and serum IL-6 in the first day after administered into ICU(r=0.682 and 0.613,P=0.001 and 0.000,respectively).Compared with the patients in the fentanyl group,the level of serum CRP,IL-6,cTnT and NT-proBNP significantly decreased in the remifentanil group(P<0.05)and their decreasing degree were more than above(P<0.05).The APACHE-II scores and SOFA scores in the remifentanil group were lower than those in the fentanyl group on third day after patients administeredinto ICU (P < 0.05). The ICU stay time of the patients in the remifentanil group and the fentanyl group is (5.5 ±2.3) days and (8.3 ± 4.6) days (P = 0.014), respectively, and the difference was statistically significant (P < 0.05).Conslusions The study shows that the light sedation based on remifentanil analgesia can alleviate the inflammatoryresponse and the myocardial injury, and provided significant improvement in symptom severity and shorten the ICUstay time in the septic cardiomyopathy patients.