持续镇痛在急性呼吸窘迫综合征治疗中的作用  

Effectiveness of continuous sedation and analgesia in acute respiratory distress syndrome after severe chest trauma:report of 21 cases

作　　者：许月明[1] 游波[1] 冯春森[1] 陈虎平[1] 

机构地区：[1]解放军第324医院心胸外科,重庆400020

出　　处：《第三军医大学学报》2010年第18期2014-2017,共4页Journal of Third Military Medical University

摘　　要：目的探讨持续镇静镇痛治疗严重胸外伤合并多发伤后急性呼吸窘迫综合征的可行性和安全性。方法选取本科自2002年5月至2009年12月收治的严重胸部创伤合并多发伤患者ARDS72例,其中21例采用我们自己配制的镇痛泵进行静脉持续镇静镇痛并配合使用纳洛酮治疗(Ⅰ组),28例行单纯持续镇痛镇静(Ⅱ组)、23例行间断镇痛镇静(Ⅲ组)。所有患者连续动态监测血压、心电图、心率(HR)、血氧饱和度(SaO2);不定期检测血常规、血气分析,通过呼吸机监测自主呼吸的潮气量(Vt)、分钟通气量(MVV)、治疗前后气道压(Paw)、平台压(Pplat),计算氧合指数(OI),对呼吸功能改善情况、并发症情况、机械通气时间和住ICU时间进行对比分析。结果 3组患者经过机械通气治疗24h后缺氧症状均有明显改善,OI改善明显,均无明显CO2潴留(P>0.05),但Paw、Pplat下降,OI升高,Vt及MVV在Ⅰ组改善最显著(P<0.05),Ⅰ组呼吸抑制、肺部感染、心功能不全以及心律失常等并发症均低其他两组(P<0.05),但Ⅰ、Ⅲ组出现烦躁、欣快等神经系统症状、恶心呕吐等胃肠道症状相似,且较Ⅱ组多(P<0.05)。机械通气时间与ICU停留时间均以Ⅰ组最短。结论持续镇静镇痛治疗严重胸外伤后急性呼吸窘迫综合征是安全有益的,联合纳洛酮有利于尽早脱离呼吸机。Objective To investigate the the feasibility and safety of continuous sedation and analgesia in acute respiratory distress syndrome（ARDS）after severe chest trauma complicated with multiple severe injuries.Methods A total of 72 ARDS patients with severe chest trauma and multiple severe injuries hospitalized in our department from May 2002 to December 2009 were retrospectively studied.Continuous sedation and analgesia associate with naloxone treatment（2 mg,in 6 h after removal of patients controlled analgesia）were carried out in 21 cases（group Ⅰ）,simple continuous sedation and analgesia in 28 cases（group Ⅱ）,and intermittent analgesia and sedation in 23 cases（group Ⅲ）.Continuous dynamic blood pressure,electrocardiogram,heart rate（HR）and oxyhemoglobin saturation（SaO2）were measured.Blood routine examination and blood gas analysis were carried out constantly.Medical ventilator was used to measrue spontaneous breathing tidal volume（Vt）,minute ventination volume（MVV）,airway pressure（Paw）and plateau pressure（Pplat）before and after treatment.Oxygenation index（OI）was calculated,and respiratory function,complications,ventilation time and ICU stay were analyzed.Results There was no significance among the 3 groups in injury severity score（ISS）,acute physiology and chronicity health evaluation Ⅱ（APACHE Ⅱ）score,arterial carbon dioxide partial pressure [p（CO2）],OI,Paw,and Vt.In each group after treatment,all indicators were improved and there was no significant difference in carbon dioxide retention（P〈0.05）.But Paw,Pplat and OI were increased,Vt and MVV were improved most significantly in group Ⅰ,while respiratory depression,pulmonary infection,cardiac insufficiency and cardiac arrhythmia and other complications were lower compared with those in the other 2 groups.The irritability,euphoria and other nervous system symptoms,nausea,vomiting and other gastrointestinal tract symptoms were similar to those in group Ⅲ.The mechanical ventilation time and ICU

关 键 词：胸部 创伤与损伤 急性呼吸窘迫综合征 纳洛酮 镇痛 镇静 

分 类 号：R614[医药卫生—麻醉学] R655[医药卫生—外科学]