不同镇痛镇静方法对急性呼吸窘迫综合征病人心脏功能的影响  

Effects of different sedation and analgesia treatment on heart function of patients with acute respiratory distress syndrome

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324医院心胸外科,重庆400020

出　　处：《西南国防医药》2011年第9期963-966,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨不同镇痛镇静方法对急性呼吸窘迫综合征(ARDS)机械通气病人心脏功能的早期影响。方法对我院59例ARDS患者机械通气治疗时随机分为3组,分别采用改良冬眠合剂行持续镇静镇痛治疗21例(Ⅰ组)、力月西及芬太尼持续镇静镇痛治疗19例(Ⅱ组)、力月西和芬太尼或吗啡等间断镇痛镇静19例(Ⅲ组),监测各组血液动力学和心肌酶学改变,并进行对比分析。结果 3组入ICU时体重、急性生理和慢性健康状态评分(APACHEⅡ)、氧合指数(O I)、血液动力学、心肌酶谱指标均无显著差异(P>0.05)。在治疗24 h后,血液动力学指标均有明显改善(P<0.05),但Ⅰ、Ⅱ组改善幅度相似(P>0.05),且均较Ⅲ组更明显(P<0.05)。心肌损伤的相关酶学均有不同程度变化,Ⅰ、Ⅱ组LDH、Mb均有下降(P<0.05),而CK-MB和Tn-T仅略有上升(P>0.05),Ⅲ组Mb、Tn-T、CK-MB及ASL仍然有明显升高(P<0.05)。结论镇静镇痛有利于保护ARDS病人心功能,持续镇静镇痛可能是更好的方法。Objective To investigate different sedation and analgesia treatment on heart function of the mechanically ventilated patients with acute respiratory distress syndrome（ARDS）.Methods 59 ARDS mechanically-ventilated patients in our hospital were randomly divided into three groups.21 cases received continuous sedation and analgesia with modified lytic cocktail（groupⅠ）,and 19 cases received continuous sedation and analgesia with midazolam and fentanyl（groupⅡ）,while the other 19 cases received intermittent analgesia and sedation with midazolam and fentanyl /morphine,etc（groupⅢ）.Changes of haemodynamics and myocardial zymogram in the three groups were monitored and compared.Results When the patients were admitted in the intensive care unit,there were no significant differences of the parameters among the three groups,including weight,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）,oxygenation index（OI）,haemodynamics and myocardial zymogram（P〉0.05）.After 24 h treatment,haemodynamics indexes in all the three groups were improved（P〈0.05）.GroupⅠand Ⅱhad similar improvement degree（P〉0.05）although they had more obvious improvement than group Ⅲ（P〈0.05）.Myocardial damage-related enzymology got various changes in the three groups.LDH and Mb descended significantly（P〈0.05）,while CK-MB and cTn-T increased slightly in group Ⅰand Ⅱ（P〉0.05）.Mb,cTn-T,CK-MB and ASL increased obviously in group Ⅲ（P〈0.05）.Conclusion Sedation and analgesia can protect the heart function of ARDS patients,and continuous sedation and analgesia may be the better method.

关 键 词：急性呼吸窘迫综合征 机械通气 镇痛 镇静 心功能 

分 类 号：R459.7[医药卫生—急诊医学]