摘要
目的:研究右美托咪啶联合瑞芬太尼在ICU镇痛镇静治疗中的应用效果及作用机制。方法:采用简单随机抽样选取ICU住院患者92例,采用随机数字表法均分为观察组和对照组各46例。两组均在液体复苏、抗感染以及营养支持等综合干预基础上采用瑞芬太尼进行镇痛治疗,观察组另加用右美托咪定,对照组加用丙泊酚,比较两组治疗结局、血流动力学指标、呼吸功能、应激反应水平及不良反应发生情况。结果:观察组瑞芬太尼用量、ICU住院时间及谵妄发生率均明显低于对照组(P<0.05),两组ICU病死率比较差异无统计学意义(P>0.05);观察组治疗后平均动脉压(MAP)、肺毛细血管楔嵌压(PCWP)和心输出量(CO)均无明显变化(P>0.05),对照组MAP明显升高(P<0.05),CO明显降低(P<0.05),且观察组MAP低于对照组,CO高于对照组;观察组吸气末跨肺压(Ptp-ei)、呼气末跨肺压(Ptp-ee)以及驱动压(△Ptp)均无明显变化,对照组Ptp-ei和△Ptp均明显升高(P<0.05),Ptp-ee明显降低(P<0.05),且观察组Ptp-ei和Ptp-ee高于对照组,△Ptp低于对照组;两组血糖(Glu)、皮质醇(Cor)及去甲肾上腺素(NE)水平均明显降低(P<0.05),且观察组Glu、Cor和NE低于对照组,差异均有统计学意义(P<0.05);观察组治疗期间发生恶心呕吐2例(4.35%),呼吸抑制3例(6.52%);对照组发生恶心呕吐4例(8.70%),呼吸抑制5例(10.87%),心动过缓1例(2.17%);两组不良反应比较差异无统计学意义(P>0.05)。结论:右美托咪啶联合瑞芬太尼用于ICU患者镇痛镇静治疗有利于减少谵妄发生和促进患者康复,同时对维持患者呼吸循环功能稳定,减轻机体应激反应水平和不良反应发生也具有积极作用。
Objective:To study the effect and mechanism of dexmedetomidine combined with remifentanil in analgesia and sedation in ICU.Methods:A total of 92 inpatients admitted to ICU were selected by simple random sampling and divided into observation group and control group according to the random number table method,with 46 cases in each group.The two groups were given remifentanil for analgesia therapy on the basis of comprehensive interventions of fluid resuscitation,anti-infection and nutritional support,and observation group was supplemented with dexmedetomidine while control group was supplemented with propofol.The treatment outcomes,hemodynamic parameters,respiratory function,stress response level and occurrence of adverse reactions were compared between the two groups.Results:The dosage of remifentanil,ICU stay and incidence rate of delirium in observation group were significantly lower than those in control group(P<0.05),and there was no significant difference in mortality rate in ICU between the two groups(P>0.05).After treatment,there were no significant changes in the mean arterial pressure(MAP),pulmonary capillary wedge pressure(PCWP)and cardiac output(CO)in observation group(P >0.05),and the MAP in control group was significantly increased(P<0.05)while the CO was significantly decreased(P<0.05),and the MAP in observation group was lower than that in control group while the CO was higher than that in control group.There were no significant changes in the end-inspiratory transpulmonary pressure (Ptp-ei),endexpiratory transpulmonary pressure(Ptp-ee) and driving pressure (△Ptp) in observation group,and the Ptp-ei and △Ptp in control group were significantly increased(P<0.05)while the Ptp-eewas significantly decreased(P<0.05),and the Ptp-eiand Ptp-eein observation group were higher than those in control group while the △Ptp was lower than that in control group.The levels of blood glucose(Glu),cortisol(Cor)and norepinephrine(NE) were significantly decreased in the two groups(P<0.05),and the levels of Glu,Cor and NE in observation group were lower than those in control group(P<0.05).There were 2 cases(4.35%)of nausea and vomiting,and 3 cases(6.52%)of respiratory depression during treatment in observation group,and there were 4 cases(8.70%)of nausea and vomiting,5 cases(10.87%)of respiratory depression and 1 case(2.17%)of bradycardia in control group.There were no significant differences in adverse reactions between the two groups(P>0.05).Conclusion:Dexmedetomidine combined with remifentanil for analgesia and sedation in patients in ICU is beneficial to reduce the occurrence of delirium and promote the rehabilitation of patients.It also has positive significance in maintaining the stability of respiratory circulation function and reducing the body’s stress response and occurrence of adverse reactions.
作者
蒋忠洋
孙欢
马世伟
刘渝鹏
贾超
JIANG Zhongyang;SUN Huan;MA Shiwei(Department of Critical Care Medicine,Mianyang Central Hospital,Sichuan Province,Mianyang 621000)
出处
《陕西医学杂志》
CAS
2020年第3期341-344,348,共5页
Shaanxi Medical Journal
基金
四川省卫生健康委员会科研课题(199650117).
关键词
重症监护病房
镇静
镇痛
右美托咪啶
瑞芬太尼
Intensive care unit
Sedation
Analgesia
Dexmedetomidine
Remifentanil
