苯磺酸瑞马唑仑联合舒芬太尼对ICU有创机械通气患者镇静效果的临床研究

Clinical Study on Sedative Effect of Remimazolam Benzenesulfonate Combined with Sufentanil in Patients Undergoing Invasive Mechanical Ventilation in ICU

目的:研究和分析ICU有创机械通气患者采用苯磺酸瑞马唑仑联合舒芬太尼的镇静效果。方法:将2020年5月—2022年12月在龙岩人民医院ICU进行有创机械通气治疗的100例患者通过随机数表法分为两组,对照组采用咪达唑仑联合舒芬太尼,观察组采用苯磺酸瑞马唑仑联合舒芬太尼。对比两组镇静前及给药后Richmond躁动-镇静评分(RASS),麻醉前后心率(HR)、平均动脉压(MAP)及动脉血氧饱和度(SpO_(2))变化情况,以及机械通气时间、停药睁眼时间、定向力恢复时间、ICU住院时间、用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、一秒率(FEV_(1)/FVC%)与最大呼气峰值流速(PEF)及不良事件发生情况。结果:两组镇静前(T_(0))RASS评分比较,差异无统计学意义(P>0.05);观察组给药后30 min(T_(1))、给药后4 h(T_(2))、给药后12 h(T_(3))及给药后24 h(T_(4))RASS评分较对照组低,差异有统计学意义(P<0.05)。两组麻醉前生命体征比较,差异无统计学意义(P>0.05);观察组麻醉后1 min、3 min、10 min、20 min、30 min HR、MAP水平均高于对照组,麻醉后1 min、3 min SpO_(2)水平高于对照组,差异有统计学意义(P<0.05);但两组麻醉后10 min、20 min、30 min SpO_(2)水平比较,差异无统计学意义(P>0.05)。观察组机械通气时间、停药睁眼时间、定向力恢复时间及ICU住院时间均显著短于对照组,差异有统计学意义(P<0.05)。两组机械通气前肺功能比较,差异无统计学意义(P>0.05);观察组机械通气后FVC、FEV_(1)、FEV_(1)/FVC%及PEF水平高于对照组,差异有统计学意义(P<0.05)。观察组不良事件发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:ICU有创机械通气患者采用苯磺酸瑞马唑仑联合舒芬太尼能取得理想的镇静效果,促进肺功能改善。

Objective:To study and analyze the sedation effect of Remimazolam Benzenesulfonate combined with Sufentanil in patients undergoing invasive mechanical ventilation in ICU.Method:From May 2020 to December 2022,100 patients underwent invasive mechanical ventilation in ICU of Longyan People's Hospital were randomly divided into two groups using the random number table method,the control group was treated with Midazolam and Sufentanil,the observation group was treated with Remimazolam Benzenesulfonate combined with Sufentanil.The scores of Richmond agitation and sedation scale(RASS)before sedation and after administration,the changes of heart rate(HR),mean arterial pressure(MAP)and arterial oxygen saturation(SpO_(2))before and after anesthesia,mechanical ventilation time,eye opening time after drug withdrawal,directional force recovery time,ICU hospitalization time,forced vital capacity(FVC),forced expiratory volume in the first second(FEV_(1)),one second rate(FEV_(1)/FVC%),peak expiratory flow rate(PEF)and adverse events were compared between two groups.Result:There was no significant difference in RASS score before sedation(T_(0))between two groups(P>0.05);the RASS scores at 30 min after administration(T_(1)),4 h after administration(T_(2)),12 h after administration(T_(3))and 24 h after administration(T_(4))in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the vital signs between two groups before anesthesia(P>0.05);the HR and MAP levels at 1 min,3 min,10 min,20 min,30 min after anesthesia in the observation group were higher than those in the control group,the levels of SpO_(2) at 1 min,3 min after anesthesia in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05);but there were no significant differences in the levels of SpO_(2) at 10 min,20 min and 30 min after anesthesia between two groups(P>0.05).The mechanical ventilation time,eye opening time after drug withdrawal,directional force recovery time,ICU hospitalization time in the observation group were significantly shorter than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the pulmonary function between two groups before mechanical ventilation(P>0.05);the levels of FVC,FEV_(1),FEV_(1)/FVC%and PEF after mechanical ventilation in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of adverse events in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:Remimazolam Benzenesulfonate combined with Sufentanil can achieve ideal sedative effect and improve pulmonary function in patients undergoing invasive mechanical ventilation in ICU.