右美托咪啶联合瑞芬太尼对重症监护病房机械通气患者镇静镇痛、应激反应及血流动力学的影响

Effects of dexmedetomidine combined with remifentanil on sedation and analgesia,stress reaction and hemodynamics of mechanical ventilation patients in intensive care unit

目的分析右美托咪啶联合瑞芬太尼对重症监护病房(ICU)机械通气患者镇静镇痛、应激反应及血流动力学的影响。方法采用随机数字表法将南通市第一人民医院ICU收治的64例机械通气患者分为对照组和观察组,各32例。对照组单独采用瑞芬太尼进行镇静镇痛治疗,观察组采用右美托咪啶联合瑞芬太尼进行镇静镇痛治疗。比较两组患者治疗前及治疗12 h的镇静镇痛评分、应激反应指标和血流动力学指标。结果治疗12 h,两组Richmond躁动/镇静评估量表(RASS)、行为疼痛量表(BPS)评分均显著低于治疗前,且观察组显著低于对照组(P<0.05)。治疗12 h,观察组皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平均低于治疗前及对照组(P<0.05)。治疗12 h,两组MAP、HR均较治疗前有所降低,CVP均较治疗前有所上升(P<0.05);治疗12 h,两组CVP比较,差异无统计学意义(P>0.05),观察组MAP高于对照组,HR低于对照组(P<0.05)。结论右美托咪啶联合瑞芬太尼应用于ICU机械通气患者中,有助于增强镇静镇痛效果,减轻机体应激反应,稳定血流动力学状态。

Objective To analyze the effects of dexmedetomidine combined with remifentanil on sedation and analgesia,stress reaction and hemodynamics of mechanical ventilation patients in intensive care unit(ICU).Methods A total of 64 patients with mechanical ventilation in ICU of the first people's hospital of Nantong were divided into control group and observation group by random number table method,with 32 cases in each group.The control group was treated with remifentanil alone for sedation and analgesia,and the observation group was treated with dexmedetomidine combined with remifentanil for sedation and analgesia.The sedation and analgesia scores,stress reaction indexes and hemodynamic indexes of the two groups before treatment and 12 h of treatment were compared.Results At 12 h of treatment,the scores of Richmond agitation/sedation assessment scale(RASS)and behavioral pain scale(BPS)in the two groups were significantly lower than those before treatment,and those in the observation group were significantly lower than the control group(P<0.05).At 12 h of treatment,the levels of cortisol(Cor)and adrenocorticotropic hormone(ACTH)in the observation group were lower than those before treatment and in the control group(P<0.05).At 12 h of treatment,MAP and HR in the two groups were lower than those before treatment,and CVP were higher than that before treatment(P<0.05);at 12 h of treatment,there was no significant difference in CVP between the two groups(P>0.05),MAP in the observation group was higher than that in the control group,and HR was lower than that in the control group(P<0.05).Conclusion Dexmedetomidine combined with remifentanil in patients with mechanical ventilation in ICU is helpful to enhance the sedative and analgesic effect,reduce the body's stress reaction and better stabilize the hemodynamic state.