芬太尼交替布托啡诺镇痛方案在术后机械通气患者中的应用  

A prospective,randomized study between fentanyl combined butorphanol and fentanyl alternate butorphanol in patients with postoperative mechanical ventilation

作　　者：沙桐 宗苏玉 胡梅新 管小育 吴城伦 周子威 胡浩然[2] 李露兰 陈仲清[1] SHA Tong;ZONG Su-yu;Mei-xin;GUAN Xiao-yu;WU Cheng-lun;ZHOU Zi-wei;HU Hao-ran;LI Lu-lan;CHEN Zhong-qing(Department of Critical Care Medi­cine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong,China;不详)

机构地区：[1]南方医科大学南方医院重症医学科,广东广州510515 [2]南方医科大学第一临床医学院,广东广州510515 [3]于都县第二人民医院急诊科,江西赣州342300

出　　处：《广东医学》2020年第13期1324-1328,共5页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(81701955);广东省自然科学基金资助项目(2017A030313590)。

摘　　要：目的比较芬太尼交替布托啡诺方案和芬太尼或布托啡诺单用的镇痛方案在重症医学科机械通气患者镇痛效果、镇痛及镇静药物使用量以及不良反应的发生率。方法选择107例重症医学科术后需有创机械通气超过24 h的患者,按随机数字表法分为芬太尼组(35例)、布托啡诺组(40例)、芬太尼交替布托啡诺组(32例),3组均联合丙泊酚镇静.疼痛和镇静评估工具分别选择重症监护疼痛观察量表(CPOT)和镇静-躁动评分(SAS)法记录各组患者一般资料,给药24h内平均动脉压(MAP)、心率(HR)和自主呼吸频率(RRs),累计镇痛镇静药物使用量,机械通气时长、脱机拔管时间及不良反应:结果各组相同时间点CPOT评分和SAS评分差异无统计学意义(P>0.05)。与芬太尼组比较,布托啡诺组患者用药30min时MAP和自主呼吸频率增加(P<0.05);芬太尼交替布托啡诺组中联用丙泊酚总量下降(P<0.05),>3d时间段脱机拔管时间均缩短(P<0.05)。与布托啡诺组相比,芬太尼交替布托啡诺组>3d时间段内脱机拔管时间缩短(P<0.05)。结论芬太尼交替布托啡诺镇痛方案在术后患者机械通气的镇痛效果确切,可减少镇静药物使用和缩短脱机拔管时间。Objective To compare the efficacy of sedation and analgesia, dosage, duration of mechanical ventilation(MV) and side-effects provided by a fentanyl/butorphanol-based analgesia regime with fentanyl-based or butorphanol-based regime in patients with postoperative MV. Methods This prospective study involves 107 adult postoperative patients requiring MV for more than 24 h. Patients were randomized to fentanyl/butorphanol group(n=32), fentanyl infusion group(n=35) and butorphanol group(n=40) by randomly number table method. Sedation was provided using propofol. The Critical-Care Pain Observation Tool(CPOT) and Sedation-Agitation Scale(SAS) score were used to monitor pain and sedative depth. General data, mean arterial pressure(MAP), heart rate(HR), spontaneous respiration rate(RRs), cumulative dosage of analgesics and sedatives, time on MV, time of weaning and extubation, and side-effects were recorded. Results There was no statistically significant difference in CPOT and SAS score at same time among three groups. Compared with the fentanyl group, the MAP and RRs 30 min after treatment in butorphanol group were significantly increased(P<0.05);in fentanyl/butorphanol group the cumulative dosage of propofol were significantly reduced(P<0.05), and time of weaning and extubation was significantly shortenedw in patients with MV over three days(P<0.05). Compared with the butorphanol group, time of weaning and extubation was significantly shortened in fentanyl/butorphanol group(P<0.05). Conclusion Patients in fentanyl alternate butorphanol-based analgesia protocol achieves satisfactory pain control. Compared with fentanyl group and butorphanol group, a fentanyl/butorphanol-based regimen reduces the dosage of propofol and time of weaning and extubation.

关 键 词：重症医学 布托啡诺 镇痛 机械通气 不良反应 

分 类 号：R971.2[医药卫生—药品] R452[医药卫生—药学]