呼吸重症监护室抢救性气管插管不同镇静镇痛方法的比较研究  

A Comparative Study on Different Methods of Sedation and Analgesia in Emergency Tracheal Intubations in RICU

作　　者：周菁[1] 田坤[1] 吴奎[1] 陈章[1] 肖贞良[1] 

机构地区：[1]成都军区总医院呼吸内科,四川成都610083

出　　处：《中国呼吸与危重监护杂志》2014年第3期254-258,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的比较研究不同镇静、镇痛方法用于呼吸重症监护室(RICU)抢救性气管插管的有效性及安全性。方法将110例需抢救性气管插管的危重症患者随机分为5组:①对照组:插管前不给予任何镇静、镇痛药物;②芬太尼组:插管前给予芬太尼2μg/kg,继以芬太尼2μg·kg-1·h-1维持;③盐酸右美托咪定+芬太尼组:插管前给予盐酸右美托咪定1μg/kg+芬太尼2μg/kg,继以盐酸右美托咪定0.5μg·kg-1·h-1+芬太尼2μg·kg-1·h-1维持;④咪唑安定+芬太尼组:插管前给予咪唑安定0.05 mg/kg+芬太尼2μg/kg,继以咪唑安定0.05 mg·kg-1·h-1+芬太尼2μg·kg-1·h-1维持;⑤丙泊酚+芬太尼组:插管前给予丙泊酚1 mg/kg+芬太尼2μg/kg,继以丙泊酚0.4 mg·kg-1·h-1+芬太尼2μg·kg-1·h-1维持。根据以上分组处理后行气管插管,观察并记录5组患者插管前后平均动脉压(MAP)、心率(HR)和呼吸频率(RR),氧合指数(PaO2/FiO2)指标,以及一次性插管成功率,Riker镇静和躁动评分,严重心率失常(窦性心动过缓、频发室性早搏、心室纤颤、心跳骤停)发生率等情况。结果丙泊酚+芬太尼组及咪唑安定+芬太尼组一次性插管成功率分别为95.4%和90.9%,高于盐酸右美托咪定+芬太尼组(86.4%,P<0.05),但前3组均高于芬太尼组(45.4%)和对照组(31.8%,P<0.05)。插管5 min后5组患者的PaO2/FiO2指标均高于插管前,丙泊酚+芬太尼组、咪唑安定+芬太尼组及盐酸右美托咪定+芬太尼组间比较无明显差异(P>0.05),但3组均高于对照组及芬太尼组(P<0.05)。严重心律失常发生率,盐酸右美托咪定+芬太尼组(0%)、咪唑安定+芬太尼组(9.0%)和丙泊酚+芬太尼组(9.0%)低于对照组(13.6%)及芬太尼组(18.2%,P<0.05)。插管时及插管后2 min的MAP,丙泊酚+芬太尼组、咪唑安定+芬太尼组低于盐酸右美托咪定+芬太尼组、芬太尼组及对照组(P<0.05)。插管时患者的Riker镇静和躁动评分≤4分者所占比例别为丙泊酚+芬太尼组90.9%,�Objective To explore the efficacy and safety of different sedative and analgesic methodsin emergent endotracheal intubations in RICU.Methods 110 cases of tracheal intubation in critically illpatients were divided into 5 groups randomly： ①control group（ given no sedative or analgesic drug beforeintubation） ; ② fentanyl group（ given intravenous fentanyl 2 μg/kg before intubation, followed by fentanyl2 μg·kg- 1·h- 1 maintenance ） ; ③ dexmedetomidine hydrochloride ＋ fentanyl group （ givendexmedetomidine hydrochloride 1 μg/kg ＋ fentanyl 2 μg/kg before intubation, followed by dexmedetomidinehydrochloride 0. 5 μg·kg- 1·h- 1 ＋ fentanyl 2 μg·kg- 1·h- 1 maintenance） ; ④midazolam ＋ fentanyl group（ given midazolam 0. 05 mg/kg ＋ fentanyl 2 μg/kg before intubation, followed by midazolam0. 05 mg·kg- 1·h- 1 ＋ fentanyl 2 μg· kg- 1 · h- 1 maintenance） ; ⑤ Propofol ＋ fentanyl group（ givenpropofol 1 mg/kg ＋ fentanyl 2 μg/kg before intubation, followed by propofol 0. 4 mg· kg- 1 · h- 1 ＋fentanyl 2 μg· kg- 1 · h- 1 maintenance） . The mean arterial pressure（ MAP） , heart rate（ HR） , respiratoryfrequency（ RR） , PaO2 /FiO2 , Riker sedation score and agitation were monitored before, during and afterintubations. The one-time success rate of intubation and severe arrhythmia （ sinus bradycardia, frequentventricular premature, ventricular fibrillation, and cardiac arrest） incidence rate were recorded.Results Theone-time success rates of intubations of the propofol ＋ fentanyl group （ 95. 4% ） and the midazolam ＋fentanyl group （ 90. 9% ） were higher than that in the dexmedetomidine hydrochloride ＋ fentanyl group（ 86. 4% , P 〈 0. 05） , while one-time intubation success rate of three groups were higher than that of thefentanyl group （ 45. 4% ） and the control group （ 31. 8% , P 〈 0. 05） . 5 minutes after intubation, thePaO2 /FiO2 index of 5 groups of patients were higher than those before intubation, but the PaO2 /FiO2 index oft

关 键 词：气管插管 镇静镇痛 丙泊酚 咪唑安定 盐酸右美托咪定 芬太尼 

分 类 号：R614[医药卫生—麻醉学]