ICU机械通气慢性阻塞性肺疾病患者不同镇静镇痛方式的临床研究  

Clinical Study of Different Types of Sedation and Analgesia in Patients with Mechanical Ventilation in ICU

作　　者：张赤[1] 王焱林[2] 杜朝晖[3] 张声[1] 昌晓寒[1] 张卫星[1] 

机构地区：[1]北京大学深圳医院重症监护病房,广东深圳518000 [2]武汉大学中南医院麻醉科,湖北武汉430071 [3]武汉大学中南医院重症监护病房,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2016年第2期322-326,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨不同镇静镇痛方式对ICU慢性阻塞性肺疾病(COPD)行机械通气患者的临床效果及不良反应等。方法:选择机械通气患者共162例,随机分为单纯镇痛组(A组)、咪唑安定组(B组)及丙泊酚组(C组),每组各54例,A组给予芬太尼持续静脉泵入镇痛,剂量为0.30-0.60μg/(kg·h)。B组:先静注咪唑安定0.03-0.1mg/kg,注药时间60s,然后以微量注射泵持续泵入,维持剂量为0.03-0.07mg/(kg·h);C组:先静注丙泊酚0.3-0.6mg/kg,注药时间60s,然后以微量注射泵持续泵入,维持剂量为0.30-1.20mg/(kg·h);B、C两组均给予芬太尼持续静脉泵入镇痛,剂量为0.30μg/(kg·h)。B、C两组均采用Ramsay分级标准,调整剂量使患者Ramsay评分控制在Ⅲ-Ⅴ级。分别记录起效时间,维持镇静、镇痛的剂量,3组药物对呼吸、循环(RR、SPO2、HR、MAP)等的影响,比较3组患者炎症指标和相关生化指标变化、胸部X片变化以及停用镇静、镇痛药物后完全清醒时间、拔管脱机时间和患者各种管路自行拔除的发生率及患者舒适度等。结果:镇静镇痛后A组RR、HR、MAP较B、C两组高,差异有统计学意义(P<0.05);用药后C组甘油三酯高于A、B两组,差异有统计学意义(P<0.05);治疗第8天,A组患者白细胞计数,降钙素原(PCT),TNF-α,IL-6等均较B、C两组指标降低显著,差异有统计学意义(P<0.01);A组用药期间谵妄发生率,停药后完全清醒时间、机械通气时间、肺不张发生率、拔管后舌后坠发生率均明显低于B、C两组(P<0.01或P<0.05)。结论:单纯适量镇痛应用于COPD患者,效果满意,可减少镇静药物用量、不良反应的发生,缩短在ICU的住院时间。Objective： To evaluate the effects of different types of sedation and analge chronic obstructive pulmonary disease （COPD） with mechanical ventilation a on patients of MV） in ICU. Methods： 162 patients with mechanical ventilation were randomly assigned into 3 groups. Patients in group A were given Fentanyl by intravenous pumping at 0.30-0. GOμg/（kg · h）, Group B weregiven midazolam intravenously over 60 seconds,with the initial dose of 0.03-0.1 mg/kg, and then by intravenous pumping at 0. 03-0.07 mg/（kg · h）, while the patients in group C were given propofol intravenously over 60 seconds, with the initial dose of 0.3-0.6 mg/kg, then intravenous pumping at 0.30-1.20 mg/（kg · h）. In group B and C, fentanyl was given continually and intra- venously for analgesia, dose of fentanyl was kept on 0. 30 μg/（kg · h）. The dose of sedation was regulated according to Ramsay sedative score to maintain at 3-4 sedative scores in group B and C. During the course, index of hemodynamics, blood gas and inflammatory factors as well as bio- chemical indices, full recovery time, extubation time, and incidence of agitation were recorded. Results： RR, HR and MAP were higher in group A than those in other groups after treatment （P 〈0. 05）. On the eighth day, WBC, PCT, TNF-α and IL-6 were significantly lower in group A than those in other groups after treatment （P〈0.01）. The incidence of delirium,full recovery time, mechanical ventilation time and incidence of atelectasis were also less in group A（P〈0.01 or P〈0.05）. Conclusion： Moderate analgesia without sedation contributes more benefit to COPD patients with mechanical ventilation in ICU, and it is helpful to recovery.

关 键 词：重症监护病房 慢性阻塞性肺疾病 机械通气 镇静镇痛 

分 类 号：R563.8[医药卫生—呼吸系统]