重型颅脑损伤患者机械通气期间氢吗啡酮的镇痛效果分析

Analysis of Analgesic Effect of Hydromorphone During Mechanical Ventilation in Patients With Severe Traumatic Brain Injury

目的 探讨氢吗啡酮在重型颅脑损伤患者机械通气中的镇痛镇静效果。方法 选取2020年4月—2023年4月晋江市医院/上海市第六人民医院福建医院神经外科收治的80例诊断重型颅脑损伤患者为研究对象。将使用氢吗啡酮的患者作为H组,使用瑞芬太尼的患者作为R组,各40例。评估达到重症监护疼痛观察工具量表(critical-care pain observation tool,CPOT)标准的水平时间(CPOT评分≤3分),收集2组患者用药前(T0)及用药后5 min(T1)、30 min(T2)、3 h(T3)、24 h(T4)、72 h(T5)时间点的生命体征参数以及不良事件发生率。结果 H组在T2、T3、T4时间段达到镇静水平患者占比分别为77.50%、77.50%、100%,高于R组的55.00%、55.00%、90.00%,差异有统计学意义(P<0.05)。H组患者在T1、T2、T3、T4、T5时间段心率(heart rate,HR)分别为(86.20±13.40)、(83.72±9.11)、(85.32±14.05)、(87.32±14.92)、(84.88±11.21)次/min,高于R组的(80.00±9.23)、(68.33±9.56)、(79.65±10.74)、(81.36±10.53)、(80.17±11.05)次/min,差异有统计学意义(P <0.05)。H组患者在T1、T2、T3、T4、T5时间段平均动脉压(mean artery press,MAP)分别为(89.52±19.58)、(88.53±14.26)、(89.13±16.38)、(88.47±15.48)、(89.64±31.68)mmHg,高于R组的(73.13±13.21)(、75.97±9.43)、(79.50±13.51)、(81.40±8.64)、(80.18±6.31)mm Hg,差异有统计学意义(P <0.05)。H组患者在T1、T2、T3、T4、T5时间段射血分数(ejection fraction,EF)分别为(61.20±9.28)、(60.70±8.80)、(62.40±9.50)、(61.80±9.80)、(62.40±9.40)%,高于R组的(55.30±8.20)、(54.80±6.20)、(55.30±8.60)、(56.20±7.40)、(56.30±8.40)%,差异有统计学意义(P <0.05)。2组不良事件发生率比较,差异无统计学意义(P> 0.05)。结论 氢吗啡酮在重型颅脑损伤患者机械通气镇痛中起效快,对血流动力学和呼吸抑制影响较小。

Objective To investigate the analgesic and sedative effects of hydromorphone during mechanical ventilation in patients with severe traumatic brain injury.Methods A total of 80 patients diagnosed with severe traumatic brain injury admitted to department of neurosurgery,Jinjiang Municipal Hospital/Shanghai Sixth People's Hospital Fujian Campus from April 2020 to April 2023 were selected as the study subjects.Patients treated with hydromorphone were selected as the group H,while patients treated with remifentanil were selected as the group R,with 40 patients each.Evaluation of horizontal time to reach critical-care pain observation tool(CPOT)criteria(CPOT score≤3 points),collect vital sign parameters and incidence of adverse events from two groups of patients before medication(T0)and 5 min(T1),30 min(T2),3 h(T3),24 h(T4),and 72 h(T5).Results The proportion of patients who achieved sedation level in T2,T3 and T4 in group H was 77.50%,77.50%and 100%,respectively,which was higher than 55.00%,55.00%and 90.00%in group R,and the difference was statistically significant(P<0.05).The heart rate(HR)of patients in group H at T1,T2,T3,T4 and T5 were(86.20±13.40),(83.72±9.11),(85.32±14.05),(87.32±14.92)and(84.88±11.21)times/min,respectively.It was higher than that of group R(80.00±9.23),(68.33±9.56),(79.65±10.74),(81.36±10.53),(80.17±11.05)times/min,and the difference was statistically significant(P<0.05).The mean artery press(MAP)of patients in group H at T1,T2,T3,T4 and T5 were(89.52±19.58),(88.53±14.26),(89.13±16.38),(88.47±15.48),(89.64±31.68)mmHg,respectively.It was higher than that of group R(73.13±13.21),(75.97±9.43),(79.50±13.51),(81.40±8.64),(80.18±6.31)mmHg,and the difference was statistically significant(P<0.05).The ejection fraction(EF)of patients in group H at T1,T2,T3,T4 and T5 were(61.20±9.28),(60.70±8.80),(62.40±9.50),(61.80±9.80),and(62.40±9.40)%,respectively.It was higher than that of group R(55.30±8.20),(54.80±6.20),(55.30±8.60),(56.20±7.40),(56.30±8.40)%,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusion Hydromorphone has a rapid effect on mechanical ventilation analgesia in patients with severe head injury,and has little impact on hemodynamics and respiratory inhibition.