瑞芬太尼和芬太尼在机械通气患者镇痛镇静中的应用效果比较

Comparison effects of Remifentanil and fentanyl in analgesia and sedation of patients with mechanical ventilation

目的:观察瑞芬太尼在机械通气患者镇痛镇静中的应用效果。方法:选取2020年1月至2021年5月该院收治的84例机械通气患者进行前瞻性研究,按照随机数字表法分为对照组和观察组各42例。对照组采用芬太尼治疗,观察组采用瑞芬太尼治疗,比较两组不同时间点[用药前(T_(0))、用药后10 min(T_(1))、用药后30 min(T_(2))、用药后2 h(T_(3))]镇静(Ramsay)评分、面部表情评分(FPS)、心率(HR)水平、平均动脉压(MAP)水平、机械通气时间、拔管时间和不良反应发生率。结果:T_(0)、T_(3)时,两组Ramsay、FPS评分比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)时,观察组Ramsay评分高于对照组,FPS评分低于对照组,差异均有统计学意义(P<0.05);T_(0)、T_(3)时,两组MAP水平比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)时,观察组MAP水平低于对照组,差异有统计学意义(P<0.05);两组各时间点HR水平比较,差异均无统计学意义(P>0.05);观察组机械通气时间、拔管时间均短于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为9.52%,对照组不良反应发生率为7.14%,两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:瑞芬太尼治疗机械通气患者可缩短机械通气和拔管时间,降低T_(1)、T_(2)时FPS评分和MAP水平,提高T_(1)、T_(2)时Ramsay评分,镇痛镇静效果优于芬太尼。

Objective:To observe application effects of Remifentanil in analgesia and sedation of patients with mechanical ventilation.Methods:A prospective study was conducted on 84 patients with mechanical ventilation admitted to this hospital from January 2020 to May 2021.They were divided into control group and observation group according to the random number table method,42 cases in each.The control group was treated with Fentanyl,while the observation group was treated with Remifentanil.The sedation(Ramsay)score,the facial expression score(FPS),the heart rate(HR)level,the mean arterial pressure(MAP)level,the mechanical ventilation time,the extubation time and the incidence of adverse reactions were compared between the two groups at different time points[before treatment(T_(0)),10 min after administration(T_(1)),30 min after administration(T_(2)),2 h after administration(T_(3))].Results:At T_(0)and T_(3),there were no significant differences in the Ramsay and FPS scores between the two groups(P>0.05).At T_(1)and T_(2),the Ramsay score of the observation group was higher than that of the control group,the FPS score was lower than that of the control group,and the differences were statistically significant(P<0.05).At T_(0)and T_(3),there were no significant differences in the MAP level between the two groups(P>0.05).At T_(1)and T_(2),the MAP levels of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the HR level between the two groups at each time point(P>0.05).The mechanical ventilation time and the extubation time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions was 9.52%in the observation group and 7.14%in the control group and the difference was not statistically significant(P>0.05).Conclusions:Remifentanil can shorten the mechanical ventilation time and the extubation time,reduce the FPS scores and the MAP levels at T_(1)and T_(2),and improve the Ramsay scores at T_(1)and T_(2).Its analgesic and sedative effects are better than Fentanyl.