丙泊酚复合瑞芬太尼对急性呼吸窘迫综合征机械通气患者的镇静镇痛效果  

Sedative and analgesic effect of propofol combined with remifentanil in mechanical ventilation for acute respiratory distress syndrome

作　　者：张萌萌 赵子瑜 Zhang Mengmeng;Zhao Ziyu(Department of Critical Care Medicine,Henan Provincial People’s Hospital,Zhengzhou University People’s Hospital,Henan University People’s Hospital,Henan Key Laboratory for Critical Care Medicine,Zhengzhou Key Laboratory for Critical Care Medicine,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院、郑州大学人民医院、河南大学人民医院重症医学科,河南省危重病医学重点实验室、郑州市危重病医学重点实验室,郑州450003

出　　处：《中国实用医刊》2024年第5期39-42,共4页Chinese Journal of Practical Medicine

摘　　要：目的评估丙泊酚复合瑞芬太尼对急性呼吸窘迫综合征(ARDS)机械通气患者的镇静镇痛效果。方法抽取2022年5月至2023年5月于河南省人民医院就诊的需行机械通气的ARDS患者86例,根据用药方案分为对照组和研究组,每组43例。对照组采用咪达唑仑复合瑞芬太尼进行镇静、镇痛,研究组采用丙泊酚复合瑞芬太尼进行镇静、镇痛。比较两组患者的镇静镇痛效果、生命体征、应激和炎症相关指标、不良反应发生率。结果研究组患者镇静起效时间、苏醒时间、机械通气时间、ICU住院时间均短于对照组(P均<0.05)。镇静后30 min,两组Ramsay镇静评分均较镇静前升高,且研究组高于对照组(P<0.05)。镇静后30 min,两组患者心率、平均动脉压、呼吸频率均下降,且研究组心率、平均动脉压、呼吸频率低于对照组(P<0.05)。镇静后24 h,两组患者血清肾上腺素、去甲肾上腺素、白细胞介素-6、肿瘤坏死因子α水平均较镇静前升高,但研究组低于对照组(P<0.05)。研究组不良反应发生率(11.63%,5/43)与对照组(23.26%,10/43)比较,差异未见统计学意义(P>0.05)。结论在ARDS患者机械通气中,采用丙泊酚复合瑞芬太尼进行镇静镇痛效果显著且安全,还能缩短机械通气时间和ICU住院时间,抑制应激和炎症反应。Objective To evaluate sedative and analgesic effect of propofol combined with remifentanil on mechanically ventilated patients with acute respiratory distress syndrome(ARDS).Methods A total of 86 ARDS patients who received mechanical ventilation in Henan Provincial People’s Hospital from May 2022 to May 2023 were selected.And they were divided into a control group and a study group using therapeutic regimen,with 43 cases in each group.The control group was treated with midazolam combined with remifentanil for sedation and analgesia,and the study group was treated with propofol combined with remifentanil for sedation and analgesia.The sedative and analgesic effects,vital signs,stress and inflammation related indicators,and the incidence of adverse reactions were compared between the two groups.Results The onset time of sedation,recovery time,mechanical ventilation time,and length of intensive care unit stay of the study group were shorter than those of the control group(all P<0.05).Thirty minutes after sedation,the Ramsay sedation scores in both groups increased compared with the scores before sedation,and the Ramsay sedation score in the study group was higher than that in the control group(P<0.05).Thirty minutes after sedation,the heart rate,mean arterial pressure,and respiratory rate of both groups decreased,and the above indicators in the study group were lower than those in the control group(P<0.05).Twenty-four hours after sedation,the serum levels of adrenaline,norepinephrine,interleukin-6,and tumor necrosis factor-αin both groups increased compared with preoperative levels,but the above indicators in the study group were lower than those in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the study group(11.63%,5/43)and the control group(23.26%,10/43),P>0.05.Conclusions Propofol combined with remifentanil has significant sedative and analgesic effects and safety in ARDS patients with mechanical ventilation.It can also reduce mechani

关 键 词：呼吸窘迫综合征 丙泊酚 瑞芬太尼 机械通气 镇静 

分 类 号：R563.8[医药卫生—呼吸系统]