两种镇静镇痛方法在抢救性气管插管的对比研究

Comparative Study of Two Methods of Sedation and Analgesia in Rescue Tracheal Intubation

目的:研究舒芬太尼联合咪唑安定镇静镇痛诱导以替代芬太尼联合咪唑安定方案的有效性和安全性。方法:选择2019年1月1日至2020年6月30日入住本院重症医学科因各种原因须气管插管的患者80例,分组方式为简单随机分组,分为舒芬太尼组40例和芬太尼组40例,舒芬太尼组:插管前静脉给予舒芬太尼0.25~0.5μg/kg+咪唑安定0.025~0.05mg/kg;芬太尼组:插管前静脉给予芬太尼0.5~1μg/kg+咪唑安定0.025~0.05mg/kg;给予药物后4~5min,立即气管插管。观察并记录患者插管前、插管时、插管后两组患者的血压、心率、血氧饱和度、呼吸频率;同时监测插管时反流误吸、呼吸暂停、心律失常、插管成功需要的次数、一次性插管成功率、全身麻醉诱导期呛咳发生率及严重情况。结果:芬太尼组和舒芬太尼组,患者的平均动脉压、呼吸频率、血氧饱和度和心率差异均有统计学意义(P均<0.001),患者入院基础值,插管前,插管后,患者的上述指标差异均有统计学意义(P均<0.001),且不同组别与时间存在交互作用,同一时间点两组间差异均有统计学意义(P均<0.001)、同一组内不同时间点间,平均动脉压、血氧饱和度出现逐渐升高趋势,呼吸频率、心率出现逐渐降低趋势(P均<0.001)。舒芬太尼组在返流误吸,呼吸暂停,心律失常发生率均低于芬太尼组(P<0.05)。舒芬太尼组插管成功需要耗费的次数少于芬太尼组,一次性插管成功率高于芬太尼组(P<0.05)。舒芬太尼组出现呛咳程度好于芬太尼组(P<0.05)。结论:舒芬太尼联合咪唑安定镇静镇痛诱导较芬太尼联合咪唑安定方案更安全可靠。

Objective:To study the efficacy and safety of sufentanil combined with midazolam to induce sedation and analgesia to substitute fentanyl combined with midazolam.Methods:A total of 80 patients admitted to the Department of Intensive Medicine of our hospital for tracheal intubation due to various reasons were selected from January 1,2019 to June 30,2020.The grouping method was simple random grouping,and they were divided into sufentanil group and fentanyl group(40 cases in each).Sufentanil group used sufentanil 0.25-0.5μg/kg+midazolam 0.025-0.05mg/kg before intravenous intubation;Fentanyl group used before intubation Tani 0.5-1μg/kg+midazolam 0.025~0.05mg/kg;4-5min after administration of the drug,tracheal intubation was conducted immediately.The blood pressure,heart rate,oxygen saturation,and respiratory rate of the two groups of patients were recorded before intubation,during intubation,and after intubation;at the same time,the reverse inhalation,apnea,arrhythmia,and intubation success during intubation were monitored.The required number of times,the success rate of one-time intubation,the incidence of choking cough during the induction period of general anesthesia and the serious situation were monitored.Results:In the fentanyl group and the sufentanil group,the differences in the mean arterial pressure,respiratory rate,blood oxygen saturation,and heart rate were statistically significant(all P<0.001),the patient's basic data,before and after intubation data showed statistically significant difference(all P<0.001),and there were interactions between different groups and time,the differences between the two groups at the same time point were statistically significant(all P<0.001).The same group at different time points within the period,the mean arterial pressure and blood oxygen saturation gradually increased,and the respiratory rate and heart rate gradually decreased(all P<0.001).Sufentanil group had lower incidence of reflux aspiration,apnea,and arrhythmia than fentanyl group(P<0.05).Sufentanil group required less successful intubation than the fentntanyl group(P<0.05).The degree of choking in sufentanil group was better than that in the fentanyl group(P<0.05).Conclusion:Sufentanil combined with midazolam is safer and more reliable than fentanyl combined with midazolam.