CAJ | 학술논문

目的观察瑞芬太尼对重症监护病房(ICU)机械通气患者镇痛、镇静治疗的效果,对机械通气时间、血流动力学的影响以及药物不良反应.方法 60例肿瘤术后需有创机械通气超过24 h的患者按随机数字表法分为芬太尼组(30例)及瑞芬太尼组(30例),分别给予芬太尼和瑞芬太尼持续静脉泵入镇痛、镇静,疼痛的评估选择面部表情评分法(FPS),镇静的评估选择Ramsay评分法(RS),必要时加用丙泊酚镇静治疗.两组患者在治疗期间执行每日唤醒策略,分别记录两组用药前后的FPS、RS和生命体征,加用丙泊酚及每日中断药物以唤醒的病例数,机械通气时间、住ICU时间、住ICU费用,以及不良反应发生情况.结果两组患者均可达到满意的镇痛、镇静目标.两组间镇痛、镇静深度总体无明显差异,但用药30 min时芬太尼组FPS(分)明显高于瑞芬太尼组(3.70±1.20比2.70± 1.17,P＜0.05)；两组间仅用药30 min时瑞芬太尼组平均动脉压(MAP,mm Hg,1 mm Hg=0.133 kPa)较芬太尼组明显下降(72.9±6.9比77.6±9.1,P＜0.05),其余生命体征无明显差异.芬太尼组有更多的患者需要加用丙泊酚镇静(19例比8例),并需中断药物(12例比4例,均P＜0.05)；而瑞芬太尼组用药30 min和1、6、24 h时自主呼吸频率(RRs,次/min)均较芬太尼组明显降低(7.0±2.8比10.4±3.5,5.4±3.4比10.6±3.6,5.4±3.0比7.2±3.1,6.1±3.0比9.2±3.4,均P＜0.05).瑞芬太尼组机械通气时间(h)、住ICU时间(h)均较芬太尼组明显缩短(73.6±26.7比94.9±37.3,125.9±37.1比150.8±50.9,均P＜0.05),但住ICU费用(万元)则无明显差异(6.06±2.29比5.83±2.38,P＞0.05).瑞芬太尼组出现低血压的患者数比芬太尼组多(8例比2例,P＜0.05).结论瑞芬太尼用于ICU机械通气患者与经典治疗效果相当,且起效迅速,能缩短机械通气时间,减少镇静剂的用量,无严重不良反应.
목적 관찰서분태니대중증감호병방(ICU)궤계통기환자진통、진정치료적효과,대궤계통기시간、혈류동역학적영향이급약물불량반응.방법 60례종류술후수유창궤계통기초과24 h적환자안수궤수자표법분위분태니조(30례)급서분태니조(30례),분별급여분태니화서분태니지속정맥빙입진통、진정,동통적평고선택면부표정평분법(FPS),진정적평고선택Ramsay평분법(RS),필요시가용병박분진정치료.량조환자재치료기간집행매일환성책략,분별기록량조용약전후적FPS、RS화생명체정,가용병박분급매일중단약물이환성적병례수,궤계통기시간、주ICU시간、주ICU비용,이급불량반응발생정황.결과 량조환자균가체도만의적진통、진정목표.량조간진통、진정심도총체무명현차이,단용약30 min시분태니조FPS(분)명현고우서분태니조(3.70±1.20비2.70± 1.17,P＜0.05)；량조간부용약30 min시서분태니조평균동맥압(MAP,mm Hg,1 mm Hg=0.133 kPa)교분태니조명현하강(72.9±6.9비77.6±9.1,P＜0.05),기여생명체정무명현차이.분태니조유경다적환자수요가용병박분진정(19례비8례),병수중단약물(12례비4례,균P＜0.05)；이서분태니조용약30 min화1、6、24 h시자주호흡빈솔(RRs,차/min)균교분태니조명현강저(7.0±2.8비10.4±3.5,5.4±3.4비10.6±3.6,5.4±3.0비7.2±3.1,6.1±3.0비9.2±3.4,균P＜0.05).서분태니조궤계통기시간(h)、주ICU시간(h)균교분태니조명현축단(73.6±26.7비94.9±37.3,125.9±37.1비150.8±50.9,균P＜0.05),단주ICU비용(만원)칙무명현차이(6.06±2.29비5.83±2.38,P＞0.05).서분태니조출현저혈압적환자수비분태니조다(8례비2례,P＜0.05).결론 서분태니용우ICU궤계통기환자여경전치료효과상당,차기효신속,능축단궤계통기시간,감소진정제적용량,무엄중불량반응.
Objective To prospectively assess the effect of remifentanil for analgesia and sedation,the impact on sustenance duration of mechanical ventilation and hemodynamics,and also its adverse reaction in the mechanically ventilated patients in the intensive care unit (ICU).Methods Sixty patients with invasive mechanical ventilation for over 24 hours after tumor operation were randomly allocated to fentanyl group (n=30) or remifentanil group (n =30) to receive a persistent infusion of either fentanyl or remifentanil for sedation and analgesia.The level of analgesia was assessed according to facial pain scale (FPS),while the level of sedation was assessed according to the Ramsay score (RS).A propofol infusion was started if additional sedation was necessary.During the therapy,the daily awakening procedure was performed,and the scores of FPS and RS and the vital signs were recorded respectively before and after medication.The number of patients receiving additional propofol infusion,and number of daily interruption of medication and that of daily arousal,the duration of mechanical ventilation,ICU length of stay,and ICU cost were recorded.Furthermore,the incidence of adverse reactions was documented.Results The ideal targets of analgesia and sedation were reached in both groups.There were nearly no significant differences between the groups with respect to the effect of sedation and analgesia.However,the FPS scores in fentanyl group at the 30 minutes of the medication were obviously higher than those of remifentanil group (3.70 ± 1.20 vs.2.70 ± 1.17,P＜0.05).The mean arterial pressure (MAP,mm Hg,1 mm Hg=0.133 kPa) of remifentanil group at 30 minutes was significantly lower than that of fentanyl group (72.9 ± 6.9 vs.77.6 ± 9.1,P＜0.05).There was no difference between two groups with respect to the other vital signs.More patients in fentanyl group needed the additional propofol infusion (19 vs.8) and interruption of medication (12 vs.4,both P＜0.05).The spontaneous breathing frequency (RRs,bpm) in patients of remifentanil group was lower obviously at 30 minutes and 1,6,24 hours than that of fentanyl group (7.0 ± 2.8 vs.10.4 ± 3.5,5.4 ± 3.4 vs.10.6 ±3.6,5.4 ± 3.0 vs.7.2 ± 3.1,6.1 ± 3.0 vs.9.2 ± 3.4,all P＜0.05).The duration of mechanical ventilation (hours) and ICU length of stay (hours) were shortened in remifentanil group compared with fentanyl group (73.6 ± 26.7 vs.94.9 ±37.3,125.9 ± 37.1 vs.150.8 ± 50.9,both P＜0.05).With respect to the cost of hospitalization (10 thousand),no significant difference was found between two groups (6.06 ± 2.29 vs.5.83 ± 2.38,P＞0.05).The number of patients showing hypotension was much more in remifentanil group than that of fentanyl group (8 vs.2,P＜0.05).Conclusions The effect of remifentanil was similar to that of the conventional therapy.Remifentanil gives rapid effect,shortens the duration of mechanical ventilation,reduces the dosage of propofol,and has no severe adverse effect.