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舒芬太尼对机械通气重症患者的镇痛镇静作用

Effect of sufentanil on analgesia and sedation for ventilated critically ill patients

摘要:

目的:比较舒芬太尼与芬太尼在外科患者机械通气期间的镇痛效果,探讨其合理使用剂量及加用镇静药物的情况。方法采用前瞻性随机对照研究方法,选择2013年4月至2015年3月昆明医科大学第二附属医院重症医学科收治的外科术后(除外神经外科术后)机械通气12~72h的重症患者600例。将患者按随机数字表法分为两组,分别使用舒芬太尼、芬太尼进行镇痛治疗,每组300例。两组患者初始镇痛剂量分别为舒芬太尼5μg/h、芬太尼50μg/h,并调整镇痛药物剂量;镇痛目标为术后疼痛评分(Prince-Henry评分)0~1分,Richmond躁动-镇静评分(RASS)-1~0分。如果患者出现躁动,则分别给予负荷剂量舒芬太尼5μg或芬太尼50μg,5min后症状无改善则静脉推注丙泊酚1mg/kg。观察两组患者镇痛药物使用剂量、加用丙泊酚的比例及剂量,并记录不良反应的发生情况。结果使用舒芬太尼镇痛患者维持镇痛目标的平均剂量为(0.07±0.02)μg·kg-1·h-1,使用芬太尼者平均剂量为(0.67±0.12)μg·kg-1·h-1;两组患者均在夜间加用丙泊酚40~60mg/h,且舒芬太尼组加用丙泊酚比例略低于芬太尼组(25.7%比28.3%),差异无统计学意义(P>0.05)。按年龄进行亚组分析发现,≥80岁患者舒芬太尼或芬太尼的平均镇痛剂量较70~79岁、60~69岁和<60岁者小,但并未达到统计学意义。舒芬太尼组和芬太尼组分别有11例(3.7%)和21例(7.0%)患者出现呼吸抑制,但未达到统计学差异(P=0.069);两组患者镇痛过程中血流动力学稳定,且无一例因躁动意外拔管。结论使用(0.07±0.02)μg·kg-1·h-1较小剂量舒芬太尼即可实现外科术后机械通气患者的满意镇痛,但需要加用40~60mg/h小剂量丙泊酚以改善焦虑、睡眠的患者比例稍低于芬太尼。

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abstracts:

Objective To compared analgesic effect of sufentanil and fentanyl in surgery patients during mechanical ventilation, and to explore the rational dosage of analgesic and sedative drugs. Methods A prospective randomized controlled trial was conducted. 600 postoperative critically ill patients underwent mechanical ventilation for 12-72 hours admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from April 2013 to March 2015 were enrolled. They were randomly divided into two groups, sufentanil and fentanyl was used for analgesia respectively, and 300 patients in each group. The initiate dosage of sufentanil and fentanil was 5 μg/h and 50 μg/h, and the dosage was adjusted. A postoperative pain score (Prince-Henry score) of 0-1, and Richmond agitation-sedation scale (RASS) score -1-0 were targeted. 1 mg/kg of propofol was used if patient could not fall in sleep or felt anxious after loading dose of sufentanil (5 μg) or fentanil (50 μg) for 5 minutes. The use of analgesic drugs, the proportion and dosage of propofol was observed in the two groups, and adverse reactions were recorded. Results The mean dose of sufentanil for analgesia was (0.07±0.02) μg·kg-1·h-1, and the mean dose of fentanyl was (0.67±0.12) μg·kg-1·h-1. The patients in the two groups received propofol 40 to 60 mg/h in night, and the use proportion of propofol in sufentanil group was slightly less than that in fentanyl group (25.7% vs. 28.3%), but the difference was not statistically significant (P > 0.05). It was found by subgroup age analysis that, the mean analgesic dose of sufentanil or fentanyl in patients over 80 years old was lower than that in 70-79 years, 60-69 years and < 60 years groups but without statistical significance. There were 11 cases (3.7%) and 21 cases (7.0%) patients suffered from respiratory depression in sufentanil group and fentanyl group, respectively, without statistical significance (P = 0.069). The hemodynamics of patients in two groups was stable during analgesia, and no accidental extubation due to restlessness was found. Conclusions A smaller dose of sufentanil for postoperative patients underwent mechanical ventilation with satisfactory analgesia was (0.07±0.02) μg·kg-1·h-1, but need to be added with 40-60 mg/h and a small dose of propofol to improve anxiety and sleep. The proportion of patients needing propofol addition was slightly lower than that of fentanyl.

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作者: 岳锦熙 [1] 黄青青 [1] 苏美仙 [1] 万林骏 [1] 李晖 [1] 刘欧亚 [1] 吴海涛 [1]
期刊: 《中华危重病急救医学》2016年28卷6期 563-566页 MEDLINEISTICPKUCSCD
栏目名称: 短篇论著
DOI: 10.3760/cma.j.issn.2095-4352.2016.06.018
发布时间: 2016-07-21
基金项目:
云南省卫生科技计划项目
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