艾司氯胺酮联合瑞芬太尼在重症肺炎有创机械通气患者镇痛镇静中的疗效及安全性评价  

Evaluation of efficacy and safety of esketamine combined with remifentanil for analgesia and sedation in patients with severe pneumonia undergoing invasive mechanical

作　　者：苗磊 廖静贤 申潇竹 杜志强 王言理[3] MIAO Lei;LIAO Jingcian;SHEN Xiaozhu;DU Zhiqiang;WANG Yani(Department of Critical Care Medicine,Lianyungang Hospital Affiliated to Xuzhou Medical U-niversity,the Second People's Hospital of Lianyungang,Lianyungang,Jiangsu,222000,Chi-na;Department of Geriatrics,Lianyungang Hospital Affiliated to Xuzhou Medical University,the Second People's Hospital of Lianyungang;Department of Emergency Medicine,the First People's Hospital of Lianyungang)

机构地区：[1]徐州医科大学连云港临床学院(连云港市第二人民医院)重症医学科,江苏连云港222000 [2]徐州医科大学连云港临床学院(连云港市第二人民医院)老年医学科 [3]连云港市第一人民医院急诊医学科

出　　处：《临床急诊杂志》2023年第5期243-248,共6页Journal of Clinical Emergency

基　　金：江苏省老年健康科研资助项目(No:LD2021034);连云港市卫生健康青年科技项目(No:QN202210)

摘　　要：目的:评价艾司氯胺酮联合瑞芬太尼在重症肺炎有创机械通气患者镇痛镇静中的疗效及安全性。方法:这项单中心的随机对照研究在连云港市第二人民医院重症医学科进行,将纳入患者随机分为研究组(瑞芬太尼联合艾司氯胺酮)和对照组(瑞芬太尼联合丙泊酚),2组患者行经口气管插管机械通气后均给予镇痛镇静治疗。随访28d,剔除失访及退出,根据不同临床转归,分为死亡组和生存组。结果:最后纳入统计分析的研究组75例,对照组75例。2组在病死率、ICU住院时间和机械通气时间上均差异无统计学意义(P>0.05);但是研究组的停药后唤醒时间少于对照组[(27.12±6.87) min vs.(33.89±8.62)min,P<0.05],瑞芬太尼总量少于对照组[(23.72±20.05)g vs.(32.31±21.82)g,P<0.05]。研究组的低血压、呼吸抑制发生率显著低于对照组(20.00%vs. 37.30%,13.30%vs. 28.00%,P<0.05),而研究组的谵妄发生率高于对照组(45.30%vs. 28.00%,P<0.05)。死亡组的年龄显著大于生存组[(73.64±14.81)岁vs.(65.79±15.88)岁,P<0.05];死亡组的机械通气时间、停药后唤醒时间以及瑞芬太尼用药总量均显著大于生存组(P<0.05);死亡组的低血压、心动过缓、呼吸抑制、反流及谵妄的发生率均显著高于生存组(44.00%vs. 21.00%,46.00%vs. 25.00%,40.00%vs. 11.00%,30.00%vs. 9.00%,50.00%vs. 30.00%,均P<0.05)。logistic回归显示:停药后唤醒时间,低血压,呼吸抑制,反流是患者死亡的主要危险因素(P<0.05)。结论:瑞芬太尼联合艾司氯胺酮具有较好的镇痛镇静效果,可减少瑞芬太尼药物使用量,缩短停药后唤醒时间,且未增加不良反应发生风险,可作为重症肺炎机械通气患者镇痛镇静治疗方案的选择之一。Objective:To evaluate the efficacy and safety of esketamine combined with for analgesia and seda-tion in patients with severe pneumonia undergoing mechanical ventilation.Methods:This single-center randomized controlled trial was conducted in the Department of Critical Care Medicine,the Second People's Hospital of Li-anyungang.Patients were randomly divided into study group(remifentanil combined with esketamine,RK group)and control group(remifentanil combined with propofol,RP group).The patients were followed up for 28 days,and the loss to follow-up and withdrawal were excluded.According to different clinical outcomes,the patients were divided into death group and survival group.Results:There were 75 cases in the study group and 75 cases in the control group.There were no significant differences in mortality rate,length of ICU stay and mechanical ven-tilation time between the two groups(P>0.05).However,the wake-up time after drug withdrawal in the study group was less than that in the control group(27.12±6.87 vs.33.89±8.62,P<0.05),and the total dose of remifentanil in the study group was less than that in the control group(23.72±20.05 vs.32.31±21.82,P<0.05).The incidences of hypotension and respiratory depression in the study group were significantly lower than those in the control group(20.00%vs.37.30%,13.30%vs.28.00%,P<0.05),while the incidence of delirium in the study group was higher than that in the control group(45.30%vs.28.00%,P<0.05).The age of death group was significantly older than that of survival group(73.64±14.81 vs.65.79±15.88,P<0.05).The duration of mechanical ventilation,wake-up time after withdrawal and total dose of remifentanil in the death group were significantly than those in the survival group(P<o.05).The incidences of hypotension,bradycardia,respiratory depression,reflux and delirium in the death group were significantly higher than those in the survival group(44.00%vs.21.00%,46.00%vs.25.00%,40.00%vs.11.00%,30.00%vs.9.00%,50.00%vs.30.00%,P<0.05).Logistic regression analysis showed th

关 键 词：重症肺炎 机械通气 镇痛镇静 艾司氯胺酮 瑞芬太尼 

分 类 号：R563.1[医药卫生—呼吸系统]