镇痛联合镇静药物的早期应用对于多发伤患者生存的临床意义  

Clinical significance of early application of analgesia combined with sedative drugs in improvement of the survival of patients with multiple injuries

作　　者：杨志龙 王海兰[2] 郭建华[3] 唐瑾 陈晓剑 袁国庆 YANG Zhilong;WANG Hailan;GUO Jianhua;TANG Jin;CHEN Xiaojian;YUAN Guoqing(Intensive Care Unit of Jian Hospital of Shanghai Oriental Hospital,Jian,Jiangxi 343100,China;Intensive Care Unit of Jian Central People’s Hospital,Jian,Jiangxi 343100,China;Intensive Care Unit of Shanghai Oriental Hospital,Shanghai 200120,China;Department of Orthopedics of Jian Hospital of Shanghai Oriental Hospital,Jian,Jiangxi 343100,China)

机构地区：[1]上海市东方医院吉安医院重症监护室,吉安343100 [2]江西省吉安市中心人民医院重症监护室,吉安343100 [3]上海市东方医院重症监护室,上海200120 [4]上海市东方医院吉安医院骨科,吉安343100

出　　处：《上海医药》2023年第16期30-32,52,共4页Shanghai Medical & Pharmaceutical Journal

基　　金：江西省吉安市科技计划项目(2021864)。

摘　　要：目的:探讨镇痛联合镇静药物的早期应用对于改善多发伤患者生存的临床意义。方法:选取2020年5月至2021年7月上海市东方医院吉安医院收治的多发伤患者120例,采用随机数字表法均分为单纯镇静组、早期联合组与72 h联合组。单纯镇静组患者入ICU后早期给予帕瑞昔布钠镇静治疗,40 mg+5 mL生理盐水静脉注射,1次/d;早期联合组患者入ICU后早期给予帕瑞昔布钠镇静治疗,同时联合右美托咪定注射液0.7μg·kg^(-1)·h^(-1)持续静脉泵注镇痛;72 h联合组患者在72 h后给予帕瑞昔布钠镇静联合右美托咪定镇痛治疗。三组均治疗1周,比较三组患者的住院时间、治疗1周后生化指标检测结果、28 d死亡率、早期评分预估死亡率及总体死亡率差异。结果:早期联合组、72 h联合组住院时间及治疗1周后血清C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、白细胞介素-6(interleukin-6,IL-6)值均低于单纯镇静组(P<0.05),且早期联合组低于72 h联合组(P<0.05)。早期联合组28 d死亡率、早期评分预估死亡率、总体死亡率均低于单纯镇静组和72 h联合组,差异有统计学意义(P<0.05);72 h联合组28 d死亡率、早期评分预估死亡率、总体死亡率均低于单纯镇静组,但数据间对比差异无统计学意义(P>0.05)。结论:早期使用镇痛联合镇静药物能提升多发伤治疗预后,提高患者生存率,值得临床推荐。Objective:To explore the clinical significance of early application of analgesia combined with sedatives drugs in improvement of the survival of patients with multiple injuries.Methods:One hundred and twenty patients with multiple injuries admitted to Jian Hospital of Shanghai Oriental Hospital from May 2020 to July 2021 were selected and divided into a simple sedation group,an early combination group,and a 72 hour combination group by the random number table method.After being admitted to the ICU,the simple sedation group received early sedation treatment with paroxicib sodium,intravenous injection of 40 mg+5 mL of physiological saline,once a day;the early combination group were treated with early sedation paroxycoxib sodium,simultaneously combined with dexmedetomidine injection 0.7μg·kg^(-1)·h^(-1) continuous intravenous pump analgesia after being admitted to the ICU;after 72 hours,the 72-hour combination group was given paroxycoxib sodiumsedation combined with dexmedetomidine analgesic treatment.All three groups were treated for one week,and the differences in hospitalization time,biochemical test results one week after treatment,28-day mortality rate,early score estimated mortality rate,and overall mortality rate were compared among the three groups of patients.Results:The results of serum C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)in the early combination group and 72-hour combination group were lower than those in the simple sedation group(P<0.05);the early combination group was lower than the 72-hour combination group.The 28-day mortality,early score estimated mortality rate and overall mortality rate in the early combination group were lower than those in the simple sedation group,and 72-hour combination group,and there was statistically significant(P<0.05);the 28-day mortality,early score estimated mortality rate and overall mortality rate in the 72-hour combination group were lower than those in simple sedation group,and there was no statistically significant(P>0.05).Conclusion:

关 键 词：多发伤 镇痛 镇静 生存率 

分 类 号：R971.3[医药卫生—药品]