瑞芬太尼在机械通气患者镇痛镇静中的应用研究

Study on the application of remifentanil in analgesia and sedation of patients with mechanical ventilation

中文关键词: 瑞芬太尼  镇痛  镇静  机械通气

英文关键词: Remifentanil  Analgesia  Calm  Mechanical ventilation

中文摘要:

      目的：观察瑞芬太尼对重症加强医疗病房（Intensive Care Unit，ICU）机械通气患者镇痛、镇静的临床疗效及不良反应。方法：选择2017年12月1日至2019年12月25日在甘肃医学院附属医院（原平凉市人民医院）ICU拟行有创机械通气的106名患者，按随机数字表法分为芬太尼组（53例）及瑞芬太尼组（53例），分别给予芬太尼和瑞芬太尼持续静脉泵入镇痛、镇静。两组患者在治疗期间分别记录两组用药前后的CPOT、RASS和MAP、HR、SpO₂，用药后的不良反应及谵妄发生情况。结果：用药30min时芬太尼组MAP明显高于瑞芬太尼组，用药30min和60min时瑞芬太尼组的HR低于芬太尼组（P＜0.05），其余生命体征无明显差异。芬太尼组用药30min时CPOT明显高于瑞芬太尼组（P＜0.05），其余时间点镇痛、镇静深度差异无统计学意义。瑞芬太尼组患者谵妄、呕吐发生率较芬太尼组减少（P＜0.05），两组恶心发生率无明显差异（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，从而在一定程度上减少谵妄的发生。

英文摘要:

      Objective: To observe the clinical efficacy and adverse reactions of remifentanil on analgesia and sedation of patients receiving mechanical ventilation in intensive care unit (ICU). Methods: Choose December 1,2017 to December 25,2019 in Pingliang City People's Hospital ICU fitting line of invasive mechanical ventilation, 106 patients according to random number table method divided into fentanyl group (53 cases) and remifentanil group (53 cases) were given fentanyl and remifentanil continuous intravenous pumping analgesia, sedation. CPOT, RASS, MAP, HR, SpO₂ before and after administration were recorded for patients in the two groups during treatment. Adverse reactions and delirium after administration were observed. Results: The MAP of the fentanyl group was significantly higher than that of the remifentanil group at 30 minutes of medication, and the HR of the remifentanil group was lower than that of the fentanyl group at 30 and 60 minutes of medication (P＜0.05), and there was no significant difference in other vital signs. The CPOT in the fentanyl group was significantly higher than that in the remifentanil group at 30 minutes (P＜0.05), and there was no significant difference in the depth of analgesia and sedation at other time points. The incidence of delirium and vomiting in the remifentanil group was lower than that in the fentanyl group (P＜0.05), and there was no significant difference in the incidence of nausea between the two groups (P＞0.05). Conclusion: The efficacy of remifentanil in ICU patients with mechanical ventilation is comparable to that of classical treatment, and its rapid onset can shorten the time of mechanical ventilation and reduce the dosage of sedatives, thus reducing delirium to some extent.