瑞芬太尼在ICU机械通气患者中的应用研究

Application research of remifentanil in patients with mechanical ventilation in ICU

目的 探讨瑞芬太尼在ICU机械通气患者中的应用价值.方法 选取2015年1月~2016年6月我科收治的机械通气患者30例,随机分为舒芬太尼组、瑞芬太尼组,均同时予以丙泊酚镇静治疗.入组患者均以重症监护疼痛观察工具(CPOT)进行镇痛评分,以Richmond镇静躁动评分(richmondagitation sedation scale,RASS)进行镇静评分.观察并记录两组患者用药前及达满意镇静镇痛后0、4、8、12、16、20、24h时RASS评分、CPOT评分、心率(HR)、自主呼吸频率(RR)、平均动脉压(MAP),并记录丙泊酚剂量、达满意镇静镇痛时间、机械通气时间、ICU住院时间.结果 两组患者用药后RASS、CPOT评分较用药前明显降低(P<0.05),均能达到满意的镇静、镇痛效果,两组比较差异无统计学意义(P>0.05).两组患者用药后HR、MAP、RR较用药前均明显降低(P<0.05),两组患者间心率变化差异无统计学意义(P>0.05),瑞芬太尼组患者达满意镇静镇痛即刻MAP较舒芬太尼组相比下降明显(P<0.05),其余各时间点MAP比较差异无统计学意义(P>0.05),瑞芬太尼组用药后各时间点RR均较舒芬太尼组明显降低(P<0.05).瑞芬太尼组丙泊酚用量较舒芬太尼组低(P<0.05),瑞芬太尼组达满意镇静镇痛时间、使用呼吸机时间、ICU住院时间均较舒芬太尼组明显缩短(P<0.05).结论 瑞芬太尼起效快,可以充分镇痛,减少了镇静药物的使用,缩短呼吸机使用时间及ICU住院时间.

Objective To evaluate the effect of remifentanil for mechanically ventilated patients in Intesive Care Unit.Methods Thirty patients with intensive mechanical ventilation selected from Jan 2015 to Jun 2016 were randomly allocated to sufentanil group and remifentanil group,all patients were sedated by propofol. The level of analgesia was assessed according to Critical Care Pain Observation Tool(CPOT),while the level of sedation was assessed according to the richmondagitation sedation scale(RASS),the scores of RASS and CPOT,heart rate(HR),spontaneous respiration rate(RR),mean arterial pressure(MAP)were recorded before medication and 0h,4h,8h,12 h,16h,20 h and 24 h after respect effect sedation and analgesia. The doses of propofol,the time to respect effect sedation and analgesia,the duration of mechanical ventilation and ICU length of stay were recorded. Results The score of RASS and CPOT after medication all reduced obviously compared with those before medication(P<0.05),the ideal targets of analgesia and sedation were reached in both groups, there were no significant differences in the two groups with RASS and CPOT before and after medication(P>0.05). HR,RR and MAP after medication were reduced obviously in two groups than those before medication(P<0.05),there were no significant differences in both groups with HR before and after medication(P<0.05). MAP of remifentarnil group at 0h after respect effect sedation and analgesia was significantly lower than that of sufentanil group(P<0.05), there were no significant differences in other time points with the MAP of remifentarnil compared with those of sufentanil group(P>0.05). RR in patients of remifentanil groups was lower obviously at each time point after medication than those of sufentanil group(P <0.05). The doses of propofol of remifentanil group was lower than that of sufentanil group(P <0.05). The time of respect effect sedation and analgesia,the duration of mechanical ventilation and ICU length of stay of remifentarnil group were shortened compared with those of sufentanil group(P <0.05). Conclusion Remifentanil has rapid effect,lower dosage of sedative,shorter duration of mechanical ventilation and time of hospitalization in ICU.