布托啡诺联合右美托咪定对重症加强治疗病房患者镇痛镇静的疗效分析  

An analysis of sedative and analgesic effects of butorphanol combined with dexmedetomidine on critically illpatients in intensive care unit

作　　者：苏俊[1] 张颖[2] 胡炜[1] 李晴宇[1] 

机构地区：[1]杭州市第一人民医院ICU,浙江杭州310006 [2]杭州市第七人民医院,浙江杭州310013

出　　处：《中国中西医结合急救杂志》2016年第2期168-171,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙汀省医学会临床科研基金项目（2013ZYC-A36）;杭州市第一人民医院集团项目（2015YJB02）

摘　　要：目的探讨布托啡诺与右美托咪定联用在重症加强治疗病房（ICU）患者中的镇痛镇静效果。方法选择杭州市第一人民医院ICU2013年10月至2015年10月收治的危重症患者108例，按随机数字表法分为芬太尼联合咪达唑仑组（芬＋咪组，58例）和布托啡诺联合右美托咪定组（布＋右组，50例）。芬＋咪组首先静脉注射（静注）负荷剂量芬太尼0．05～0．10mg、咪达唑仑0．05-0．10mg／kg进行镇痛镇静诱导，然后改用微量注射泵持续泵人芬太尼0．5mg＋咪达唑仑50mg（以0．05～0．15mg·kg^-1·h^-1）维持；布＋右组首先静注布托啡诺10μg／kg负荷剂量，然后微量注射泵持续泵人布托啡诺10-20μg·kg^-1·h^-1，联合缓慢静注右美托咪定4mg／L维持。采用躁动-镇静评分（RASS）评估镇静效果，行为疼痛量表（BPS）评估镇痛效果，拔除气管插管后按数字疼痛评分（NRS）法评估疼痛情况，采用意识模糊评估量表评价ICU综合征情况，从镇静开始后每8h评估1次，将两组患者的镇静深度维持在理想范围。观察两组患者用药前后平均动脉压（MAP）、心率（HR）、指脉搏血氧饱和度（SpO2）的变化。结果用药后两组患者MAP、HR均较用药前降低，SpO2较用药前升高，但两组间比较差异无统计学意义（均P〉0．05）。布＋右组药物起效时间较芬十咪组延长（min：31．6±7．9比30．5±1．2），停药后完全清醒时间（min：39．2±8．7比121．7±30．6）、拔管时间（min：102．9±13．9比189．2±17．1）均较芬＋咪组缩短（均P〈0．05）。布＋右组重度呛咳反应患者数（2例比25例）、拔管后恶心的发生率[10．0％（5／50）比10．3％（6／58）]较芬＋咪组明显减少；RASS（分：-1．6±0．2比-3．2±0．1）、BPS（分：2．9±0．4比2．7±0．3）较芬＋咪组升高，NRS（分：3．6±0．7比8．4±1．3）较芬＋咪组降低；用药过程中及拔管�Objective To study the sedative and analgesic effects of butorphanol combined with dexmedetomidine on patients in intensive care unit （ICU）. Methods 108 patients who received sedative and analgesic therapies in ICU of Hangzhou First People＇s Hospital from October 2013 to October 201,5 were enrolled. They were divided into a fentanyl combined with midazolam group （fentanyl ＋ midazolam group, 58 cases） and a butorphanol combined with dexmedetomidine group （butorphanol ＋ dexmedetomidine group, 50 cases） according to the random number table method. The induction of sedation and analgesia for patients in the fentanyl ＋ midazolam group was firstly by intravenous injection of load dosage 0.05 - 0.10 mg fentanyl and 0.05 - 0.10 mg/kg midazolam and followed by continuous infusion of fentanyl 0.5 mg and midazolam 50 mg （0.05 - 0.15 mg · kg^-1·h ^-1） with a micro injection pump to maintain the therapy. The patients in the butorphanol ＋ dexmedetomidine group were given a loading dose of butorphanol 10 μg/kg and followed by continuous infusion of 10 - 20 μg·kg^-1· h^-1 butorphanol by a micro pump and combined with slowly intravenous injection of 4 mg/L dexmedetomidine to maintain the therapy. The Richmond Agitation-Sedation Scale （RASS） and Behavioral Pain Scale （BPS）, after tracheal extubation, Numeric Rating Scale （NRS） was used were applied to assess the sedative and analgesic effects; and the assessment scale for ICU patients with confusion was used to carry out the evaluation of ICU syndrome situation. From the beginning of sedation, the evaluation was performed once every 8 hours and the sedation depths of patients in the two groups were maintained at the range of ideal grades. The changes of mean arterial pressure （MAP）, heart rate （HR） and pulse blood oxygen saturation （SpO2） were observed before and after the drug administration, and the therapeutic situations of sedatives and analgesics were recorded in the two groups. Results After the drug administration, MAP

关 键 词：布托啡诺 右美托咪定 芬太尼 咪达唑仑 重症加强治疗病房 镇痛镇静 

分 类 号：R454[医药卫生—治疗学]