布托啡诺联合右美托咪定在高脂血症性重症急性胰腺炎机械通气患者镇痛镇静中的应用

Application of Butorphanol Combined with Dexmedetomidine on Analgesia and Sedation in Mechanically Ventilated Patients with Hyperlipidemic Severe Acute Pancreatitis

目的:探讨布托啡诺联合右美托咪定在高脂血症性重症急性胰腺炎机械通气患者镇痛镇静中的应用价值。方法:回顾性分析2020年3月至2023年2月湘西土家族苗族自治州人民医院重症监护室诊治的103例高脂血症性重症急性胰腺炎患者的病例资料,根据机械通气时的镇痛镇静方案分为观察组(53例,硬膜外阻滞+布托啡诺+右美托咪定)和对照组(50例,硬膜外阻滞+布托啡诺)。统计两组患者用药前至用药120 h时的镇痛镇静效果、炎症因子水平及治疗期间的药品不良反应。结果:两组患者用药48 h时,重症监护疼痛观察工具(CPOT)评分均降低,且用药48~120 h处于逐渐降低趋势,与用药前相比,差异均有统计学意义(P<0.05);观察组患者用药48~120 h的CPOT评分低于对照组,差异有统计学意义(P<0.05)。两组患者用药48 h时Ramsay镇静评分较用药前升高;观察组患者用药72~120 h的Ramsay镇静评分低于对照组,差异均有统计学意义(P<0.05)。用药后,两组患者血清白细胞介素(IL)1β、IL-6和肿瘤坏死因子α水平较用药前降低,观察组患者低于对照组,差异均有统计学意义(P<0.05)。两组患者谵妄、震颤、低血压、心动过缓和呕吐等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:布托啡诺联合右美托咪定用于高脂血症性重症急性胰腺炎机械通气患者,能强化镇痛镇静效果,提高抗炎作用,且未增加药品不良反应。

OBJECTIVE:To probe into the application value of butorphanol combined with dexmedetomidine on analgesia and sedation in mechanically ventilated patients with hyperlipidemic severe acute pancreatitis.METHODS:Clinical data of 103 patients with hyperlipidemic severe acute pancreatitis diagnosed and treated in ICU department in the People’s Hospital of Xiangxi Tujia and Miao Autonomous Prefecture were retrospectively analyzed,which were divided into observation group(53 cases,epidural block+butorphanol+dexmedetomidine)and control group(50 cases,epidural block+butorphanol)according to the analgesic and sedative schemes during mechanical ventilation.The analgesic and sedative effects and inflammatory factors levels from before medication to 120 h of medication,and the incidence of adverse drug reaction during treatment were statistically analyzed.RESULTS:In both groups,the Critical Care Pain Observation Tool(CPOT)scores were lower at 48 h of medication,and were in a decrease trend from 48 h and 120 h of medication,the differences were statistically significant compared with those of before medication(P<0.05);the CPOT scores of the observation group were lower than those of the control group from 48 h and 120 h of medication,with statistically significant differences(P<0.05).The Ramsay sedation score of both groups at 48 h of medication was higher than that before medication;the score of the observation group was lower than that of the control group from 72 h to 120 h of medication,with statistically significant differences(P<0.05).After medication,the serum interleukin(IL)1β,IL-6 and tumour necrosis factorαlevels of both groups were lower than those before medication,and those of the observation group were lower than the control group,with statistically significant differences(P<0.05).In the comparisons of the incidence of adverse drug reactions such as delirium,tremor,hypotension,bradycardia and vomiting between two groups,the differences were not statistically significant(P>0.05).CONCLUSIONS:The application of butorphanol combined with dexmedetomidine on mechanically ventilated patients with hyperlipidaemic severe acute pancreatitis can strengthen the analgesic and sedative effect,improve the anti-inflammatory effect,without increasing adverse drug reactions.