Sedation and analgesia in gastrointestinal endoscopy: What’s new?

Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endoscopy would include rapid onset and offset of action,analgesic and anxiolytic effects,ease of titration to desired level of sedation,rapid recovery and an excellent safety prof ile.Therefore there is an impulse for development of new approaches to endoscopic sedation.This article provides an update on the methods of sedation today available and future directions in endoscopic sedation.

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands

BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

Process Management of Analgesia and Sedation Can Reduce the Incidence of Delirium

Background: Critical patients in ICU have to experience pain, anxiety, and sleep deprivation which always cause delirium, which will prolong the hospital stay and come up with higher mortality. Analgesia based sedation can reduce the accumulation of sedative effects, and shorten ventilator time and ICU length of stay. Process management of analgesia and sedation can reduce the incidence of delirium. Objectives: To explore the clinical benefits of procedural analgesia and sedation for critical ill patients. Methods: This is a prospective, two-phase study that focuses on patients who required mechanical ventilation after surgery. Comparing patients’ pain and agitation scores, the species and dosage of sedative and analgesic, the incidence of delirium in the observation period and intervention period, data in two groups were collected and analyzed. Results: During the observational and interventional periods, we enrolled 213 patients before protocol implantation and 196 patients after protocol implantation. We found that there existed impropriate pain and sedation assessment in patients involved, and after training for procedural protocol, the average dosage of sedatives was decreased (p > 0.05). The percentage of reaching standard COPT score was 73.7% vs 84.1% (p > 0.05) and RASS score was 70.9% vs 79.6% (p > 0.05) in the observation period and intervention period, and the incidence of delirium was significantly reduced (31.9% vs 23.5%, p Conclusion: We concluded that protocol implantation of analgesia and sedation can reduce the incidence of delirium.

End-tidal capnometry during emergency department procedural sedation and analgesia： a randomized, controlled study

BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

Study on Analgesia and Sedation of Butorphanol Tartrate Combined with Dexmedetomidine in Severe Cerebral Hemorrhage for Patients with Mechanical Ventilation

Objective: To analyze the effect and advantages in analgesia and sedation of butorphanol tartrate combined with dexmedetomidine in severe cerebral hemorrhage for patients with mechanical ventilation. Methods: 120 patients with severe cerebral hemorrhage requiring analgesia and sedation were randomly selected and divided into two groups: the control group (dexmedetomidine treatment group) and the test group (dexmedetomidine combined with butorphanol tartrate). Two groups of patients with different drugs were analyzed. Results: The average dose of dexmedetomidine (microgram) and the total adverse events (Times) in the test group were significantly lower than those in the control group within 48 hours (P < 0.05);The dose of Butorphanol in the test group was small, and the patients in the control group used other opioid analgesics to pump more significantly. Conclusion: Using butorphanol tartrate combined with dexmedetomidine can achieve the same sedative effect and enhance the analgesic effect as using dexmedetomidine alone with less dose of dexmedetomidine, and the clinical effect is significant. It also solves the problem that adverse reactions such as blood pressure change and bradycardia are easy to occur when using large dose of dexmedetomidine and the infusion speed is fast in clinical application, and significantly reduces the incidence of adverse reactions. It is worthy of clinical application.

Monitoring salivary amylase activity is useful for providing timely analgesia under sedation

AIM:To detect the criteria and cause of elevated salivary amylase activity(sAMY)in patients undergoing endoscopic submucosal dissection(ESD)under sedation.METHODS:A total of 41 patients with early gastric cancer removed via ESD under deep sedation(DS)were enrolled.The perioperative sAMY,which was shown as sympathetic excitements(SE),was measured.The time at which a patient exhibited a relatively increased rate of sAMY compared with the preoperative baseline level(IR,%)≥100%(twice the actual value)was assumed as the moment when the patient received SE.Among the 41 patients,we focused on 14 patients who exhibited an IR≥100% at any time that was associated with sAMY elevation during ESD(H-group)and examined whether any particular endoscopic procedures can cause SE by simultaneously monitoring the sAMY level.If a patient demonstrated an elevated sAMY level above twice the baseline level,the endoscopic procedure was immediately stopped.In the impossible case of discontinuance,analgesic medicines were administered.This study was performed prospectively.RESULTS:A total of 26 episodes of sAMY eruption were considered moments of SE in the H-group.The baseline level of sAMY significantly increased in association with an IR of>100% at 5 min,with a significant difference(IR immediately before elevation/IR at elevation of sAMY=8.72±173/958±1391%,P<0.001).However,effective intervention decreased the elevated sAMY level immediately within only 5 min,with a significant difference(IR at sAMY elevation/immediately after intervention=958±1391/476±1031,P<0.001).The bispectral indices,systolic blood pressure and pulse rates,which were measured at the same time,remained stable throughout the ESD.Forceful endoscopic insertion or over insufflation was performed during 22 of the 26 episodes.Release of the gastric wall tension and/or the administration of analgesic medication resulted in the immediate recovery of the elevated sAMY level,independent of body movement.CONCLUSION:By detecting twice the actual sAMY based on the preoperative level,the release of the gastric wall tension or the administration of analgesic agents should be considered.

Airway Characteristics and Safe Management of Spontaneously Breathing Patients: Risks of Sedation and Analgesia and Changes in Wakefulness

The goal of safe airway management is to maintain a patent airway. Lack of knowledge of the anatomical morphology and changes that may occur in the upper airway during sedation and unconsciousness may lead to critical incidents and hazardous complications. This review focuses on the risks of sedation and analgesia and changes in wakefulness on airway patency in spontaneously breathing patients. Furthermore, key elements of airway management are presented and discussed.

Sedation in gastrointestinal endoscopy: Current issues

Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation.Moreover,the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and,consequently,its low risk of inducing hepatic encephalopathy.In the future,propofol could become the preferred sedation agent,especially for routine colonoscopy.Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam.Among opioids,pethidine and fentanyl are the most popular.A number of other substances have been tested in several clinical trials with promising results.Among them,newer opioids,such as remifentanil,enable a faster recovery.The controversy regarding the administration of sedation by an endoscopist or an experienced nurse,as well as the optimal staffing of en-doscopy units,continues to be a matter of discussion.Safe sedation in special clinical circumstances,such as in the cases of obese,pregnant,and elderly individuals,as well as patients with chronic lung,renal or liver disease,requires modification of the dose of the drugs used for sedation.In the great majority of patients,sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide.In this review,an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.

Effects of DEX on sedation, neurological function and cerebral oxygen metabolism in elderly patients with prostate cancer undergoing LRP

Objective:To study the sedative effect of dexmedetomidine in elderly patients with prostate cancer undergoing three hole LRP,and its effect on nerve function and brain oxygen metabolism.Methods:From August 2016 to December 2019,78 patients with LRP under general anesthesia in our hospital were randomly selected and divided into control group and observation group according to the random number table method,39 cases in each group.During the operation,the observation group was given dextromethoridine,while the control group was given the same amount of normal saline.The changes of cognitive function index(MoCA score,POCD incidence rate),neurological function index(TGF-β1,NSE,IGF-1),brain oxygen metabolism index(PaO2,map,PaCO2,rSO2)before and after operation were compared between the two groups.The visual analogue score(VAS),the amount of analgesic drugs and the times of pressing the analgesic pump were compared between the two groups.The incidence of adverse reactions was compared between the two groups.Results:Before operation,there was no significant difference in cognitive function index,neurological function index and brain oxygen metabolism index between the two groups(P>0.05).On the first and third days after operation,MOCA score of the two groups was significantly lower,MOCA score of the observation group was significantly higher than that of the control group,POCD incidence of the observation group was significantly lower than that of the control group;on the third day after operation,TGF-β1 and IGF-1 of the two groups were significantly lower,TGF-β1 and IGF-1 of the observation group were significantly lower-The NSE in the observation group was significantly lower than that in the control group(P<0.05).In this study,1 hour after the establishment of pneumoperitoneum,PaCO2 and rSO2 in the two groups were significantly increased,6 hours and 12 hours after the operation,the VAS score of the observation group was lower than that of the control group,and the dosage of analgesic pump and the number of times of compression of the analgesic pump were significantly lower than that of the control group(P<0.05).There was no difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:DEX has a good sedative effect on the elderly prostate cancer patients undergoing LRP with three hole method.It has little effect on nerve function and brain oxygen metabolism,and has a good safety.

目标性镇痛镇静联合心理干预在ICU清醒患者中的应用研究

目的探讨目标性镇痛镇静联合心理干预在重症监护病房(Intensive Care Unit,ICU)清醒患者中的应用。方法方便选取2021年9月—2023年9月在广西壮族自治区民族医院重症医学科接受治疗的84例清醒患者作为研究对象,按随机数表法分为观察组(n=42)和对照组(n=42)。对照组采取常规镇痛镇静护理;观察组采取目标性镇痛镇静联合心理干预。分别采用心理健康状态评估表评估两组患者入住ICU第1天、第4天、转出ICU当天的心理状态;采用焦虑自评量表(Self-rating Anxiety Scale,SAS)、抑郁自评量表(Self-rating Depression Scale,SDS)分别评估两组患者入住ICU第1天、转出ICU当天的抑郁、焦虑情况;采用匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)分别评估两组患者入住ICU第1天、转出ICU当天睡眠情况;同时统计两组患者在ICU的住院天数。结果观察组入住ICU第4天、转出ICU当天的心理健康状态评分显著高于对照组,差异有统计学意义(P均<0.05);观察组患者转出ICU当天的焦虑、抑郁情况显著低于对照组,差异有统计学意义(P均<0.05)。观察组患者转出ICU当天的PSQI评分显著低于对照组,且在ICU住院天数也显著短于对照组,差异有统计学意义(P均<0.05)。结论目标性镇痛镇静联合心理干预在ICU清醒患者中应用能改善患者不良心理、睡眠质量,缩短患者在ICU住院天数。

基于eCASH理念的镇静镇痛护理模式在重症脑外伤患者术后应用的价值研究

目的探讨基于舒适化浅镇静策略(Early Comfort Using Analgesia,Minimal Sedatives and Maximal Hu⁃mane Care,eCASH)理念的镇静镇痛护理模式在重症脑外伤患者术后应用的价值。方法随机选取2021年1月—2023年1月福建医科大学附属协和医院收治的重症脑外伤患者90例为研究对象,按随机数表法分为对照组和镇静镇痛护理模式组,每组45例。对照组患者接受临床重症脑外伤手术患者常规护理,镇静镇痛护理模式组患者在常规护理基础上加入基于eCASH理念的镇静镇痛护理模式。对比两组患者的镇静镇痛效果、生活质量。结果干预1周后,镇静镇痛护理模式组患者疼痛行为量表的面部表情、上肢活动、呼吸机顺应性评分值均低于对照组患者(P均<0.05)。出院当日,镇静镇痛护理模式组生活质量综合评定量表中躯体功能(16.11±2.54)分、生理状态(17.74±2.04)分、心理功能(15.11±2.12)分、社会功能(16.71±2.88)分均高于对照组(t=4.580、6.548、7.450、5.838,P均<0.05)。结论基于eCASH理念的镇静镇痛护理模式应用于重症脑外伤手术患者中,可有效提高镇痛镇静效果、促进术后康复、提升生活质量。

低剂量艾司氯胺酮复合丙泊酚在无痛结肠镜检查中的麻醉效果观察

目的 观察低剂量艾司氯胺酮复合丙泊酚在无痛结肠镜检查中的麻醉效果。方法 68例行无痛结肠镜检查的门诊患者,按随机数字表法分为观察组和对照组,各34例。观察组给予低剂量艾司氯胺酮+丙泊酚进行麻醉,对照组单纯使用丙泊酚进行麻醉。比较两组患者不同时间点[麻醉前(T1)、进肠镜时(T2)、肠镜至脾曲时(T3)、肠镜至肝曲时(T4)、肠镜至回盲瓣时(T5)]生命体征[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))]、麻醉相关指标(麻醉起效时间、苏醒时间、丙泊酚总用量、明显体动反应情况)、镇静镇痛效果及不良事件发生情况。结果 T1时,两组MAP、HR、SpO_(2)比较,差异无统计学意义(P>0.05);T2、T3、T4、T5时,两组MAP、HR、SpO_(2)均低于T1时,但观察组MAP、HR、SpO_(2)均高于对照组,差异有统计学意义(P<0.05)。观察组麻醉起效时间(19.38±3.23)s、苏醒时间(7.92±1.41)min均短于对照组的(30.74±3.60)s、(12.41±1.38)min,丙泊酚总用量(106.00±16.05)mg少于对照组的(147.44±18.34)mg,明显体动反应占比35.3%低于对照组的67.6%,差异有统计学意义(P<0.05)。观察组镇静镇痛优良率64.7%高于对照组的32.4%,差异有统计学意义(P<0.05)。观察组注射疼痛、循环抑制、呼吸抑制、心动过缓发生率分别为17.6%、11.8%、14.7%、8.8%,均明显低于对照组的55.9%、38.2%、44.1%、35.3%,差异有统计学意义(P<0.05);两组恶心呕吐发生率比较,差异无统计学意义(P>0.05)。结论 低剂量艾司氯胺酮复合丙泊酚用于无痛结肠镜检查中镇静镇痛效果理想,相较单纯使用丙泊酚,患者的生命体征更稳定,更安全。

艾司氯胺酮在小儿围术期应用进展

艾司氯胺酮在患儿术前用药、术中麻醉、术后镇痛、门诊及日间手术中已应用广泛。术前用药可有效缓解患儿术前焦虑,促进患儿与父母的顺利分离,术前应用艾司氯胺酮不但有利于相对平稳的麻醉诱导过程,而且能够产生更少的精神不良反应及口腔分泌物。患儿术中持续输注低剂量艾司氯胺酮可有效降低阿片类药物剂量,且不影响苏醒质量,并减轻术后疼痛,同时可用于患儿术后镇痛。艾司氯胺酮单一或联合其他镇静镇痛药物可安全用于患儿内镜检查及治疗、诊断性检查及有创导管置入麻醉的应用,并有效减少其他镇静药物剂量,降低不良反应发生率。本文就艾司氯胺酮在患儿上述各方面应用进展进行综述,以期为临床应用提供参考。

右美托咪定的中枢神经作用机制研究进展

右美托咪定是一种α_(2)肾上腺素受体激动剂,具有镇静、镇痛、抗焦虑、抗交感神经的作用,目前已经成为临床麻醉和重症监护室广泛应用的药物。相比于麻醉科其他药物,右美托咪定没有明显的呼吸抑制作用且没有明显的血流动力学改变,且与其他麻醉药配伍可明显减少镇静镇痛药物的用量。在临床应用中发现,右美托咪定可以介导可唤醒的镇静效应。传统认为右美托咪定通过α_(2)肾上腺素受体发挥作用,可以发挥降低血压、舒张血管和降低心率的作用,但对于其如何影响脑内神经环路尚不清楚。近年来关于右美托咪定作用机制的研究逐渐增多,证实下丘脑腹外侧视前区(ventrolateral preoptic nucleus,VLPO)、蓝斑核(locus coeruleus,LC)、中脑腹侧被盖区(ventral tegmental area,VTA)等核团参与其介导的镇静作用,背根神经节(dorsal root ganglion,DRG)、颈上神经节(superior cervical ganglion,SCG)参与其介导的镇痛作用,下丘脑视前区(preoptic area,PO)和下丘脑室旁核(paraventricular nucleus,PVN)参与其介导的体温和水电解质平衡的变化,为理解右美托咪定在中枢神经系统的作用机制提供了新的方向。

右美托咪定复合艾司氯胺酮对老年食管癌根治术患者的镇静镇痛效果、苏醒质量及认知功能的影响

目的分析右美托咪定复合艾司氯胺酮对老年食管癌根治术患者的镇静镇痛效果、苏醒质量及认知功能的影响。方法选取新疆医科大学第一附属医院2020年8月至2023年7月收治的102例拟行根治性手术治疗的老年食管癌患者为研究对象,使用简单随机法配合随机数字表法将入选患者分为复合组(n=51)和对照组(n=51)。两组术中均泵注右美托咪定维持麻醉,复合组麻醉诱导时给予艾司氯胺酮0.25 mg/kg静脉滴注,术中视麻醉深度追加艾司氯胺酮1 mg/kg静脉注射。记录两组患者入室时(T1)、手术开始前1 min(T2)、手术开始后3 min(T3)、手术结束时(T4)、苏醒时(T5)平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和血氧饱和度(oxygen saturation,SpO_(2))变化,评估两组患者镇静镇痛效果、苏醒质量和认知功能变化,并记录不良反应。结果两组患者T2、T3、T4、T5的MAP、HR较T1均显著降低(均P<0.05),且复合组患者MAP、HR均显著低于对照组同时点水平(均P<0.05)。复合组T2、T3的SpO_(2)均显著高于对照组同时点水平(均P<0.05)。两组患者术后12 h的视觉模拟评分法评分均显著高于术后6 h(均P<0.05),复合组患者术后6 h、术后12 h、术后24 h的视觉模拟评分法评分均显著低于对照组(均P<0.05)。复合组患者苏醒时间、躁动发生率、术后2 h Ricker镇静-躁动评分均显著低于对照组(均P<0.05),术后2 h时Ramsay评分显著高于对照组(P<0.05)。两组患者术后1 d、术后3 d简易精神状态量表(minimum mental state examination,MMSE)评分均显著低于本组术前1 d(均P<0.05),复合组患者术后1 d、术后3 d MMSE评分均显著高于对照组患者(均P<0.05),术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率显著低于对照组(P<0.05)。两组患者术后不良反应发生率比较差异无统计学意义(P>0.05)。结论与单纯应用右美托咪定,复合艾司氯胺酮能够达成更理想的食管癌根治术中、术后镇静镇痛效果,对于提高苏醒质量、降低术后POCD风险更有益,且安全性良好。

舒适化浅镇静策略理念对冠心病重症监护病房患者谵妄的预防效果

目的观察舒适化浅镇静策略(eCASH)理念对冠心病重症监护病房(CCU)患者谵妄的预防效果。方法回顾性分析2021年6月—2023年1月收治的136例CCU患者的临床资料。将2021年6月—2022年3月采用常规防范谵妄护理的患者纳入对照组(n=69),将2022年4月—2023年1月采用eCASH理念护理的患者纳入观察组(n=67)。比较2组患者谵妄预防效果、躁动镇静情况、CCU住院时间以及认知功能。结果观察组谵妄发生率为4.48%,低于对照组的17.39%,差异有统计学意义(P<0.05)。观察组谵妄持续时间、CCU住院时间短于对照组,差异有统计学意义(P<0.05)。干预后,2组Richmond躁动与镇静量表(RASS)评分、蒙特利尔认知评估量表(MoCA)各项指标评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组镇痛镇静药物(瑞捷、丙泊酚)平均使用剂量少于对照组,差异有统计学意义(P<0.05)。结论基于eCASH理念的镇痛镇静调控方案可降低CCU患者谵妄发生率,缩短谵妄持续时间和住院时间,改善其躁动镇静情况及认知功能。

光谱熵评价缺血性脑卒中患者镇痛镇静治疗效果的研究

目的 探讨光谱熵评估缺血性脑卒中患者镇痛镇静治疗效果的可靠性及可行性。方法 选取2021年7月至2022年11月牡丹江医学院附属红旗医院收治的64例急性缺血性脑卒中患者为研究对象,根据随机数字表法将纳入患者分为对照组和实验组,每组各32例。对照组患者根据Richmond躁动镇静量表(Richmond agitation-sedationscale,RASS)评分、重症监护疼痛观察工具(critical-care pain observation tool,CPOT)评分结果调整镇痛镇静方案,实验组患者根据光谱熵结果调整镇痛镇静方案。比较两组患者的生命体征、C反应蛋白(C-reactiveprotein,CRP)、镇静镇痛用药剂量和不良反应发生率。光谱熵值与RASS评分、CPOT评分的相关性采用Spearman相关分析。结果 实验组患者的光谱熵值与RASS评分、CPOT评分均呈正相关(r=0.719、0.556,P<0.001)。两组患者不同时点的平均动脉压、经皮动脉血氧饱和度比较差异均无统计学意义(P>0.05)。实验组患者T3时点的心率显著低于对照组(P<0.05)。T1、T2、T3时,实验组患者的CRP水平均显著低于对照组(P<0.05)。实验组患者舒芬太尼和咪达唑仑的用量均显著少于对照组(P<0.05)。实验组患者的不良反应发生率显著低于对照组(12.50%vs. 34.38%,χ^(2)=4.267,P=0.039)。结论 光谱熵可作为监测缺血性脑卒中患者镇痛镇静深度的一种客观方法,与RASS评分、CPOT评分具有较好的相关性,可降低不良反应发生率,有效避免应激反应,减少镇痛镇静药物的应用。

右美托咪定联合纳布啡术后PCIA在TURP患者术后镇痛中的应用效果

目的探讨右美托咪定联合纳布啡术后自控静脉镇痛(PCIA)对经尿道前列腺电切术(TURP)患者术后镇痛镇静及炎症指标的影响。方法选取2021年1月至2022年8月该院收治的80例TURP患者作为研究对象,按随机数字表法将其分为对照组和观察组,每组40例。对照组采用纳布啡联合托烷司琼术后PCIA,观察组在对照组基础上加用右美托咪定术后PCIA。比较两组的疼痛程度[视觉模拟评分法(VAS)]及镇静程度[Ramsay镇静评分(RSS)]、炎症指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、PCIA泵总按压次数。结果VAS评分与RSS评分均存在组间效应、时间效应和交互效应(P<0.001),且观察组术后12、24、48 h的VAS评分低于对照组(F=60.560,P<0.001;F=19.909,P<0.001;F=176.704,P<0.001),而术后12、24、48 h的RSS评高于对照组(F=26.030,P<0.001;F=48.944,P<0.001;F=66.341,P<0.001)。IL-6、TNF-α水平存在时间效应、组间效应和交互效应(P<0.001),且且观察组术后24、48 h的IL-6水平低于对照组(F=5.108,P=0.027;F=36.192,P<0.001),术后24、48 h的TNF-α水平低于对照组(F=32.844,P<0.001;F=18.879,P<0.001)。观察组术后48 h内PCIA泵总按压次数[(9.12±0.91)次]低于对照组[(13.21±1.32)次],差异有统计学意义(t=16.134,P<0.001)。结论右美托咪定联合纳布啡术后PCIA可减少TURP患者术后镇痛泵按压次数,提高镇痛镇静效果,减轻炎症反应。

以P0.1为指导的镇痛镇静对减少重度急性呼吸窘迫综合征患者肺损伤的研究

目的探讨以气道闭合压(P0.1)为指导的镇痛镇静与减少重度急性呼吸窘迫综合征(ARDS)患者肺损伤的关系,指导重度ARDS患者机械通气。方法选取2021年10月至2023年6月在绍兴市人民医院ICU接受机械通气治疗的重度ARDS患者70例为研究对象,采用随机数字表法将患者分为实验组和对照组,各35例。机械通气48 h内两组均深度镇痛镇静以消除自主呼吸。机械通气49~168 h,对照组以Richmond躁动-镇静量表(RASS)评分维持在-2~0分为目标实施镇痛镇静;实验组以P0.1作为呼吸努力强弱的量化指标,维持在1~3.5 cmH_(2)O(1 cmH_(2)O=0.098 kPa),用以指导患者实施镇痛镇静。采用ELISA法检测两组患者机械通气第48、120、168小时的血清肺表面活性蛋白D(SP-D)、涎液化糖链抗原(KL-6)水平。同时观察两组患者第48、120、168小时P0.1、氧合指数,比较两组患者死亡率。结果实验组患者机械通气第120小时[(102.73±19.25)ng/mL比(113.57±21.19)ng/mL]、第168小时[(91.28±27.47)ng/mL比(106.35±28.47)ng/mL]血清SP-D水平均低于对照组,差异均有统计学意义(均P<0.05)。两组患者第48小时血清SP-D水平及第48、120、168小时血清KL-6水平比较差异均无统计学意义(均P>0.05)。实验组患者机械通气第48小时[(1.83±0.52)cmH_(2)O比(4.05±0.62)cmH_(2)O]、第120小时[(2.28±0.46)cmH_(2)O比(4.31±0.72)cmH_(2)O]、第168小时[(2.94±0.48)cmH_(2)O比(4.23±1.06)cmH_(2)O]P0.1均低于对照组,差异均有统计学意义(均P<0.01)。两组患者第48、120、168小时氧合指数比较差异均无统计学意义(均P>0.05)。两组患者死亡率比较差异无统计学意义(P=0.597)。结论以P0.1为指导的镇痛镇静,可以降低重度ARDS患者血清肺损伤标志物SP-D值,有助于减少重度ARDS患者肺损伤。