不同镇痛镇静方式对呼吸衰竭患者血流动力学的影响  

Effect of Different Analgesia and Sedation Methods on Hemodynamics of Patients with Respiratory Failure

作　　者：赵影[1] 文海燕[1] ZHAO Ying;WEN Haiyan(Department of Critical Medicine,Baoding Second Central Hospital,Zhuozhou 072750,China)

机构地区：[1]保定市第二中心医院重症医学科,河北涿州072750

出　　处：《医学综述》2022年第8期1634-1639,共6页Medical Recapitulate

基　　金：保定市科技计划项目(2041ZF221)。

摘　　要：目的分析不同镇痛镇静方式对呼吸衰竭患者血流动力学的影响。方法选取2020年1月至2021年4月保定市第二中心医院重症医学科收治的135例行机械通气治疗的呼吸衰竭患者,按照治疗方法将其分为A组(瑞芬太尼联合咪达唑仑治疗,45例)、B组(瑞芬太尼联合右美托咪定治疗,45例)、C组(瑞芬太尼联合丙泊酚治疗,45例)。记录并比较三组用药前、用药6、12 h的Richmond躁动-镇静量表(RASS)评分、重症监护疼痛观察工具(CPOT)评分、心率、平均动脉压(MAP)、动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))变化及不良反应发生率。结果RASS评分、CPOT评分、心率、MAP的组间和时点间主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。用药6 h、12 h B组和C组的RASS评分、CPOT评分高于A组(P<0.05),C组用药6、12 h的心率、MAP低于A组和B组(P<0.05)。用药前、用药6、12 h的SaO_(2)、PaO_(2)、PaCO_(2)主效应差异有统计学意义(P<0.01),不考虑测量时间,三组SaO_(2)的主效应差异无统计学意义(P>0.05),三组SaO_(2)不存在交互作用(P>0.05),各组SaO_(2)、PaO_(2)水平均随用药时间延长而不断升高,PaCO_(2)水平均随用药时间延长而不断降低。三组呕吐、低血压、心动过速、心动过缓、谵妄的发生率以及不良反应总发生率比较差异均无统计学意义(P>0.05)。结论与瑞芬太尼联合丙泊酚和瑞芬太尼联合右美托咪定相比,瑞芬太尼联合咪达唑仑对呼吸衰竭患者的镇痛、镇静作用更明显,且能够能有效维持患者血流动力学稳定性,改善患者肺功能及预后。Objective To analyze the effect of different analgesic sedation methods on hemodynamics of patients with respiratory failure.Methods A total of 135 patients with respiratory failure treated with mechanical ventilation in the Department of Critical Medicine of Baoding Second Central Hospital from Jan.2020 to Apr.2021 were included.According to the treatment methods,they were divided into group A(remifentanil combined with midazolam,45 cases),group B(remifentanil combined with dexmedetomidine,45 cases)and group C(remifentanil combined with propofol,45 cases).The changes of Richmond agitation-sedation scale(RASS),critical-care pain observation tool(CPOT),heart rate,mean arterial pressure(MAP),arterial oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and the incidence of adverse reactions were recorded and compared among the three groups before treatment,6 and 12 hours after treatment.Results The main effects of RASS score,CPOT score,heart rate and MAP were significantly different between groups and time points(P<0.01),and there was an interaction between time points and groups(P<0.01).RASS score and CPOT score of group B and group C were higher than those of group A at 6 and 12 h after treatment(P<0.05),heart rate and MAP of group C were lower than those of group A and group B at 6 and 12 h after treatment(P<0.05).There were statistically significant differences in the main effects of SaO_(2),PaO_(2) and PaCO_(2) before medication,at 6 and 12 h after medication(P<0.01).Regardless of measurement time,there was no statistically significant difference in the main effects of SaO_(2) among the three groups(P>0.05),and there was no interaction of SaO_(2) between the three groups(P>0.05).The levels of SaO_(2) and PaO_(2) in all groups increased with the extension of medication time,while PaCO_(2) levels decreased with the extension of medication time.There were no significant differences in the incidence of vomiting,hypotension,tachycardia,bradycar

关 键 词：呼吸衰竭 镇痛 镇静 动脉血氧饱和度 动脉血氧分压 动脉血二氧化碳分压 

分 类 号：R563.8[医药卫生—呼吸系统]