布托啡诺联合右美托咪定应用于ICU多发伤患者的临床研究  

A clinical study of butorphanol tartrate combined with dexmedetomidine for treatment of patients with multiple injuries in intensive care unit

作　　者：王玥[1] 秦秉玉[2] 邵换璋[2] 黄晓佩[2] 

机构地区：[1]郑州市儿童医院麻醉科,河南郑州450000 [2]郑州大学附属人民医院重症医学科,河南郑州450000

出　　处：《中国中西医结合急救杂志》2016年第6期597-600,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河南省科技厅卫生攻关项目（201303124）

摘　　要：目的 观察布托啡诺联合右美托咪定对重症加强治疗病房（ICU）多发伤患者的镇静镇痛效果.方法 采用前瞻性研究方法,选择2015年1月至2016年5月河南省人民医院ICU收治的多发伤患者85例,按随机数字表法分为试验组（42例）和对照组（43例）.对照组给予10 mg/L芬太尼（2μg·kg-1·h^-1）联合8 mg/L右美托咪定（0.5～0.7 μg· kg-1·h^-1）持续微量泵泵入;试验组应用布托啡诺0.4 g/L（20μg·kg-1·h^-1）联合右美托咪定8 mg/L（0.5～0.7 μg·kg-1·h^-1）持续微量泵静脉输注48 h.两组均维持镇静目标Ramsay评分2～4分,重症监护疼痛观察工具（CPOT）评分达到0～3分.观察治疗前和治疗后2、6、12、24、48 h两组镇痛镇静效果;以及治疗前后呼吸频率（RR）、心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）的变化;比较两组镇静镇痛达标时间和不良反应发生情况.结果 随着治疗时间延长,两组给药后各时间点CPOT评分、Ramsay评分、HR、RR、MAP、PaO2均较给药前明显降低,PaO2、SpO2较用药前明显升高,给药后48 h达到最低[对照组：CPOT评分（分）为2.56±0.39比7.21±0.35,Ramsay评分（分）为3.34±0.69比1.12±0.25,HR（次/min）为110.52±10.98比129.21±12.36,RR（次/min）为29.09±6.38比36.04±5.15,MAP （mmHg,1 mmHg=0.133 kPa）为110.01±14.32比113.24±15.84,PaCO2（mmHg）为37.43±5.67比43.79±7.14,PaO2 （mmHg）为72.32±3.55比57.42±7.55,SpO2为0.94±0.10比0.87±0.08;试验组：CPOT评分（分）为2.01±0.72比7.67±0.73,Ramsay评分（分）为3.56±0.37比1.18±0.27,HR（次/min）为80.54±9.98比126.54±12.37,RR（次/min）为20.06±3.18比35.28±4.85,MAP（mmHg）为78.69±12.34比112.52±13.42,PaCO2 （mmHg）为35.06±4.98比43.79±6.28,PaO2 （mmHg）为97.98±7.98比58.62±6.35,SpO2为0.99±0.10比0.89±0.08];两组各时间点MAP、HR、RR、PaO2比较差异均无统计学意义�Objective To investigate the sedative and analgesic effects of combined with butorphanol tartrate dexmedetomidine on patients with multiple injuries in intensive care unit （ICU）. Methods A prospective study was conducted; 85 patients with multiple traumas admitted into ICU of Henan Provincial People＇s Hospital from January 2015 to May 2016 were randomly divided into experimental group （42 patients） and control group （43 patients） according to random number table method. The control group received fentanyl （10 mg/L, 2μg·kg^-1·h^-1） combined with dexmedetomidine （8 mg/L, 0.5-0.7μg·kg^-1·h^-1）, while the experimental group applied butorphanol tartrate （0.4 g/L, 20μg·kg^-1·h^-1） combined with dexmedetomidine （8 mg/L, 0.5-0.7μg·kg^-1·h^-1） continuing intravenous infusion by micro pump to obtain sedative and analgesic effect for 48 hours. Both groups were maintained to achieve a Ramsay score 2-4 and the critical-care pain observation tool （CPOT） score 0-3. The effects of the patients were observed before treatment and after treatment at 2, 6, 12, 24 and 48 hours. The changes of respiratory rate （RR）, heart rate （HR）, mean arterial pressure （MAP）, pulse oximetry （SpO2）, arterial oxygen partial tension （PaO2）, arterial carbon dioxide partial tension （PaCO2） were observed before and after treatment; the time reaching the sedative and analgesic standard and the incidences of side effects were observed and compared between the two groups. Results With the time extension, the CPOT score, Ramsay score, HR, RR, MAP, PaO2 at various time points of the two groups were significantly lower than those before administration of drugs, while PaO2 and SpO2 were significantly higher than those before treatment, 48 hours after the treatment reaching a minimum [control group： CPOT score was 2.56±0.39 vs. 7.21±0.35, Ramsay score was 3.34±0.69 vs. 1.12±0.25, HR （bpm） was 110.52±10.98 vs. 129.21±12.36, RR （bpm） was 29.09±6.38 vs. 36.04±5.15, MAP （mmHg,

关 键 词：布托啡诺 右美托咪定 多发伤 镇静镇痛 

分 类 号：R971.2[医药卫生—药品]