目的 观察布托啡诺联合舒芬太尼镇痛方案在重症监护病房(ICU)机械通气患者中的效果及对血流动力学的影响.方法 采用前瞻性、随机对照研究,选取2021年3月—2023年3月商丘市第三人民医院ICU收治的118例机械通气患者,按1∶1随机分为观察组、对照组各59例.观察组采取布托啡诺联合舒芬太尼镇痛方案,对照组采取舒芬太尼镇痛方案.比较两组镇静、镇痛情况(镇静起效时间、停药后苏醒时间、机械通气时间、ICU住院时间、丙泊酚总用量).以用药前(T0)、用药后6 h(T1)、12 h(T2)、24 h(T3)为时间节点,比较两组血流动力学指标[心率(HR)、平均动脉压(MAP)].以用药后6 h(t1)、12 h(t2)、18 h(t3)、24 h(t4)为时间节点,比较两组Ricker镇静-躁动评分(SAS)、重症监护疼痛观察工具(CPOT)评分.比较两组不良反应发生情况.结果 用药后观察组镇静起效、停药后苏醒、机械通气、ICU住院时间均短于对照组,丙泊酚总用量少于对照组(P＜0.05);t1～t4时观察组CPOT评分均低于对照组,SAS评分均高于对照组(P＜0.05);T1、T2、T3时观察组HR、MAP波动幅度小于对照组(P＜0.05);观察组不良反应总发生率为10.17%,与对照组15.25%相比,差异无统计学意义(P＞0.05).结论 布托啡诺、舒芬太尼联合治疗ICU机械通气患者,可有效增强镇静、镇痛效果,维持血流动力学稳定,且安全性较高,有利于促进患者病情转归.
Objective To observe the effect of butorphanol and sufentanil combined analgesia regimen in patients with mechanical ventilation in intensive care unit(ICU)and its influence on hemodynamics.Methods A prospective,randomized controlled study was carried out on 118 patients with mechanical ventilation in ICU from March 2021 to March 2023,and the enrolled patients were randomly divided into observation group and control group with 59 cases in each group.The observation group received butorphanol combined with sufentanil analgesia regimen,and the control group received sufentanil analgesia regimen.The conditions of sedation and analgesia(sedation onset time,recovery time after drug withdrawal,mechanical ventilation time,ICU stay length,total dosage of propofol)were compared between the two groups.The hemodynamic indexes[heart rate(HR)and mean arterial pressure(MAP)]of the two groups were compared before medication(T0),6 h(T1),12 h(T2)and 24 h(T3)after medication as time nodes.At 6 h(t1),12 h(t2),18 h(t3),24 h(t4)after medication,Ricker Sedation-Agitation Scale(SAS)and Critical Care Pain Observation Tool(CPOT)score were compared between the two groups.The occurrence of adverse reactions was compared between the two groups.Results The onset of sedation,recovery after drug withdrawal,mechanical ventilation and ICU stay in the observation group were shorter than those in the control group,and the total dosage of propofol was lower than that in the control group(P＜0.05).At t1 to t4,CPOT score of observation group was lower than that of control group,and SAS score was higher than that of control group(P＜0.05).The fluctuation amplitude of HR and MAP in the observation group was smaller than that in the control group at T1,T2 and T3(P＜0.05).The total incidence of adverse reactions in the observation group was 10.17%,compared with 15.25%in the control group,the difference was not statistically significant(P＞0.05).Conclusions The combination of butorphanol and sufentanil in the treatment of patients with mechanical ventilation in ICU can effectively enhance sedation and analgesia,maintain hemodynamic stability,and have high safety,which is conducive to promote the outcome of the disease.
赵一菡;李艳华;陈晶晶
商丘市第三人民医院ICU(河南商丘 476000)
布托啡诺;舒芬太尼;重症监护病房;机械通气;血流动力学;镇痛
butorphanol;sufentanil;ICU;mechanical ventilation;hemodynamics;relieve pain
《广州医药》 2024 (002)
164-169 / 6
10.3969/j.issn.1000-8535.2024.02.011
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