瑞芬太尼联合右美托咪定在ICU机械通气患者镇痛镇静中的作用

Advantages of Remifentanil combined with Dexmedetomidine on the analgesia and sedation of ICU septic patients with mechanical ventilation

关键词:  瑞芬太尼  右美托咪定  机械通气  镇痛镇静

Key words:  remifentanil  dexmedetomidine  mechanical ventilation  analgesia and sedation

摘要:

目的　观察瑞芬太尼联合右美托咪定在ICU机械通气患者中镇痛镇静的效果。方法　选取2016年6月至2017年12月入住大连医科大学附属第二医院重症医学科的行为疼痛量表（BPS评分）＞4分且Richmond躁动镇静量表（RASS评分）＞+1分的脓毒症机械通气患者，所有患者被随机分为试验组和对照组，试验组给予瑞芬太尼联合右美托咪定持续泵入镇痛镇静治疗，对照组给予瑞芬太尼持续静脉泵入镇痛治疗，其余治疗均循2014年中国严重脓毒症/脓毒性休克治疗指南。记录入组患者用药前（T0）及用药后5 min（T1）、10 min（T2）、15 min（T3）、30 min（T4）、1 h（T5）、2 h（T6）、4 h（T7）、6 h（T8）、12 h（T9）、24 h（T10）11个时间点的BPS评分、RASS评分、心率（HR）、收缩压（SBP）、舒张压（DBP）及出现不良反应例数（恶心、呕吐、低血压、心动过缓等）。统计两组患者瑞芬太尼用量、机械通气时间、ICU住院时间及28 d病死率。结果　试验组患者在T1～T2时点BPS评分≤4分，RASS评分≤1分；对照组患者在T2～T3时点BPS评分≤4分，T5～T6时点RASS评分≤1分。T2～T10各时点两组患者的HR、SBP、DBP水平差异均具有统计学意义（P<0.05）。试验组有3例（4.55%）出现心动过缓，对照组有4例（6.35%）出现心动过缓、6例（9.52%）出现低血压，差异具有统计学意义（P<0.05）。试验组患者瑞芬太尼用量、机械通气时间及ICU住院时间均少于对照组，差异具有统计学意义（P<0.05）。两组患者28 d病死率无差异（P>0.05）。结论　ICU机械通气患者联合应用瑞芬太尼及右美托咪定治疗，镇痛镇静效果更好，血流动力学更稳定，不良反应较少。

Abstract:

Objective To investigate the effects of remifentanil combined with dexmedetomidine on the analgesia and sedation of ICU sepstic patients with mechanical ventilation. Methods Septic patients with mechanical ventilation in ICU at the Second Hospital of Dalian Medical University from June 2016 to December 2017 were enrolled in the study, who had BPS scores more than 4 points and RASS scores more than 1 point. All patients were randomly divided into experimental group and control group. The patients in experimental group were given continuous intravenous infusion of remifentanil and dexmedetomidine for analgesic and sedative treatments; whereas the patients in control group were given continuous intravenous infusion of remifentanil for analgesic treatments. The remaining treatments were based on the 2014 guidelines for the treatment of severe sepsis or septic shock in China. The BPS scores, RASS scores, HR, SBP, DBP and the number of adverse event (nausea, vomiting, hypotension, bradycardia, et al) of all enrolled patients were collected before the medication (T0), and 5min (T1), 10min (T2), 15min (T3), 30min (T4), 1h (T5), 2h (T6), 4h (T7), 6h (T8), 12h (T9) and 24h (T10) after the medication. The dose of remifentanil, mechanical ventilation time, ICU hospital stay and 28 d mortality rate were compared between two groups. Results In the experimental group, the BPS scores were ≤4 points and RASS scores ≤1 point at T1-T2, while in the control group, the BPS scores were ≤4 points at T2-T3 and RASS scores ≤1 point at T5-T6. The differences of HR, SBP and DBP between two groups from T2 to T10 were statistically significant (P<0.05). There were 3 cases (4.55%) of bradycardia in the experimental group, 4 cases (6.35%) of bradycardia and 6 cases (9.52%) of hypotension in the control group. The differences were statistically significant (P<0.05). The dose of remifentanil, mechanical ventilation time and ICU hospital stays in the experimental group were all less than those in the control group (P<0.05). There was no difference in 28 d mortality between the two groups (P>0.05). Conclusion Remifentanil combined with dexmedetomidine had a better analgesic and sedative effects, more stable hemodynamics and less adverse reactions.