羟考酮对机械通气的中重度急性呼吸窘迫综合征患者胃肠道功能的影响  

Effects of oxycodone on gastrointestinal function in patients with moderate to severe acute respiratory distress syndrome undergoing mechanical ventilation

作　　者：熊盟 靳鑫 杨艳[1] 孔垂应 杨莎[1] 舒艾娅 XIONG Meng;JIN Xin;YANG Yan;KONG Chuiying;YANG Sha;SHU Aiya(Department of Intensive Care Unit,Chongqing University Fuling Hospital,Chongqing 408000,China)

机构地区：[1]重庆大学附属涪陵医院重症医学科,重庆408000

出　　处：《中国临床药理学与治疗学》2024年第11期1300-1305,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：重庆市涪陵区科卫联合医学科研项目(2022KWLH023);白求恩公益基金会恩泽疼痛管理医学研究项目(ezmr2022-078)。

摘　　要：目的:探讨羟考酮对机械通气的中重度急性呼吸窘迫综合征患者胃肠道功能的影响。方法:研究选取2022年1月至2023年6月重庆大学附属涪陵医院重症医学科收治的重症肺炎导致中重度急性呼吸窘迫综合征(ARDS)患者50例,随机分成瑞芬太尼组(n=25)和羟考酮组(n=25)分别予瑞芬太尼和羟考酮镇痛治疗。观察两组患者急性胃肠损伤(AGI)发生情况及严重程度分级、临床结局(机械通气时间、ICU住院天数和28天病死率)、胃排空指标[胃残余量(GRV)、胃排空率(GER)、胃窦运动指数(MI)]、营养状况[白蛋白(ALB)、前白蛋白(PAB)]、呼吸循环指标[静态肺顺应性(Cst)、氧合指数(OI)、二氧化碳分压(PaCO_(2))、血管活性药物评分(VIS)]。结果:瑞芬太尼组和羟考酮组患者AGI发生率无明显区别(96%vs. 72%,P=0.289),但瑞芬太尼组的AGI分级严重程度高于羟考酮组(P=0.009);羟考酮组治疗后48 h、72 h的GRV均低于瑞芬太尼组、MI则均高于瑞芬太尼组(P<0.05),而GRE则变化相近(P>0.05);羟考酮组治疗后ALB、PAB均高于治疗前(P<0.05),而瑞芬太尼组治疗前后无明显变化(P>0.05),且羟考酮组治疗后PAB高于瑞芬太尼组(P=0.035),而两组治疗前ALB、PAB及治疗后ALB则基本相似(P>0.05);两组患者的临床结局及呼吸循环指标亦无明显差异(P>0.05)。结论:羟考酮对机械通气的中重度急性呼吸窘迫综合征患者胃排空抑制更小,且发生急性胃肠损伤程度更轻,同时更能改善患者的营养状况,亦具备可靠的安全性,羟考酮可能更利于保护急性呼吸窘迫综合征患者的胃肠功能。AIM:To investigate the impact of oxy-codone on gastrointestinal function in patients with moderate to severe acute respiratory distress syn-drome undergoing mechanical ventilation.METHODS:Fifty patients with moderate to severe ARDS caused by severe pneumonia admitted to the Intensive Care Department of Fuling Hospital,Chongqing University from January 2022 to June 2023 were selected for the study.The patients were randomly divided into a remifentanil group(n=25)and a hydroxycodone group(n=25).They were treated with remifentanil and hy-droxycodone for pain relief.We observed the inci-dence and severity grading of acute gastrointestinal injury(AGI),clinical outcomes(length of mechanical ventilation,ICU length of stay,and mortality at day 90),gastric emptying indicators(GRV,GER,MI),nu-tritional status(ALB,PAB),respiratory and circulatory indicators(Cst,OI,PaCO_(2),VIS).RESULTS:The occur-rence of AGI showed no notable disparity between the remifentanil and oxycodone groups(96%vs.72%,P=0.289),yet the remifentanil group exhibited a more severe AGI rating compared to the oxycodone group(P=0.009).The oxycodone groups GRV at 48 and 72 hours post-treatment was less than the remifentanil groups,with the MI surpassing the remifentanil groups(P<0.05),and the GRE exhibited comparable alterations(P>0.05).Post-treatment,the oxycodone groups ALB and PAB levels were elevated(P<0.05),whereas the remifentanil groups pre-treatment and post-treatment PAB remained unchanged(P>0.05),and the oxycodone groups PAB exceeded the remi-fentanil groups(P=0.035).However,the ALB,PAB,and ALB levels before and post-treatment were almost identical in both groups(P>0.05).Additionally,there was no significant variance in clinical and respiratory outcomes between the two patient groups(P>0.05).CONCLUSION:Hydroxycodone has a smaller inhibitory effect on gastric emptying in patients with moderate to severe acute respiratory distress syndrome un-dergoing mechanical ventilation,and has a milder degree of acute gastrointestinal injury.It can also improve th

关 键 词：羟考酮 瑞芬太尼 重症肺炎 急性呼吸窘迫综合征 急性胃肠损伤 

分 类 号：R614[医药卫生—麻醉学]