瑞芬太尼与芬太尼应用于胸外科手术后机械通气患者镇痛的比较  

Comparison of analgesic effects between remifentanil and fentanyl in postoperative and mechanically ventilated thoracic surgical patients

作　　者：皋源[1] 张艳[1] 杭燕南[1] 孙大金[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,200127

出　　处：《上海医学》2007年第6期408-412,共5页Shanghai Medical Journal

摘　　要：目的比较胸外科手术后机械通气患者应用瑞芬太尼与芬太尼镇痛的有效性和安全性,并观察瑞芬太尼在充分镇痛后对镇静及脑电双频指数(BIS)的影响。方法选择胸外科手术后气管插管接呼吸机辅助通气的患者30例,年龄18～80岁,随机分为瑞芬太尼组和芬太尼组。当患者镇静-躁动(SAS)评分≥2分时开始给予镇痛,瑞芬太尼组予瑞芬太尼3～6μg·kg^(-1)·h^(-1)持续静脉滴注,芬太尼组予芬太尼0．5μg·kg^(-1)·h^(-1)持续静脉滴注．辅助给予1%丙泊酚(30mg单次静脉注射或0．5mg·kg^(-1)·h^(-1)静脉维持滴注),使患者保持平静状态(SAS评分为4分)。比较两组患者清醒至拔管前的疼痛视觉模拟(VAS)评分、机械通气时间和脱机时间,并分析不同瑞芬太尼剂量与BIS的关系。结果瑞芬太尼组的VAS评分、机械通气时间和脱机时间分别为(0．9±0．8)分、(4．0±0．8)h和(0．5±0．2)h,明显低于芬太尼组的(2．3±1．3)分、(5．2±0．9)h和(0．8±0．4)h (P值均＜0．05),且丙泊酚用量少于芬太尼组。瑞芬太尼的使用剂量为6μg·kg^(-1)·h^(-1)时的BIS值为63．6±6．8,明显低于剂量为3、4和5μg·kg^(-1)·h^(-1)时的BIS值(分别为74．5±5．2、73．0±5．9和71．0±4．7,P值均＜0．05)。结论瑞芬太尼的镇痛效果好于芬太尼,并具有一定的镇静作用,可缩短机械通气和脱机时间,不良反应少,是胸外科手术后气管插管机械通气患者较理想的镇痛药。Objective To compare the analgesic efficacy and safety between remifentanil and fentanyl in postoperative thoracic surgical patients undergoing mechanical ventilation, and to observe the effects of remifentanil on bispestral index（BIS） after full analgesia. Methods Remifentanil（3-6 μg · kg^-1 · h^-1 , n = 15 ） or fentanyl （0.5 μg · kg^-1 · h^-1 , n = 15 ） was infused in postoperative mechanically ventilated thoracic surgical patients（age 18-80 years） when their sedation-agitation scale（SAS） score were 〉2 point. Optimal sedation was supplemented with propofol（30 mg/kg bolus or 0.5 mg · kg^-1 · h^-1 ） to achieve an SAS score of 4. Visual analog scores （VAS）, time of extubation, weaning time of mechanical ventilation, dosage and side effects of remifentanil and fentanyl were compared between the two groups. Results Remifentanil provided better analgesia than fentanyl（VAS score： 0. 9 ± 0. 8 vs 2.3 ± 1.3, P 〈 0. 05 ）. Remifentanil significantly reduced the duration of mechanical ventilation compared to fentanyl E （4.0 ± 0. 8） h vs （5.2 ± 0.9） h, P 〈 0.05 ] and the weaning time from mechanical ventilation [ （0.5 ± 0.2） h vs （0.8 ± 0.4） h, P 〈 0.05 ]. No patient required supplemental propofol in the remifentanil group. Infusion of remifentanil at 6 μg · kg^-1 · h^-1 resulted in significantly lower BIS scores than those at 3, 4 and 5 μg · kg^-1 · h^-1 groups. Conclusion Remifentanil provides more efficient analgesia than fentanyl; it also reduces the time of extubation and weaning time of mechanical ventilation. Remifentanil appears to be a more suitable analgesic than fentanyl for postoperative thoracic surgical patients in the intensive care unit. （Shanghai Med J, 2007, 30：408-412）

关 键 词：瑞芬太尼 术后镇痛 机械通气 

分 类 号：R614[医药卫生—麻醉学]