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目的观察舒芬太尼联合右美托咪定在重症医学科(ICU)机械通气患者中的应用效果。方法选取2013年9月—2015年9月在盐城市第三人民医院ICU行机械通气患者106例,采用随机数字表法分为对照组和观察组,每组53例。常规麻醉诱导后,对照组患者持续静脉泵注舒芬太尼与咪达唑仑,观察组患者持续静脉泵注舒芬太尼与右美托咪定。比较两组患者用药后1、12、24 h Riker镇静与躁动评分(SAS);用药后6、12、24 h及拔管后疼痛行为量表(BPS)评分;用药前,用药后6、12、24 h及拔管后生命体征〔包括心率(HR)、平均动脉压(MAP)与血氧饱和度(SpO_2)〕;不良反应发生情况。结果时间与方法在SAS评分上无交互作用(P>0.05);时间在SAS评分上主效应不显著(P>0.05);方法在SAS评分上主效应不显著(P>0.05);两组患者不同时间点SAS评分比较,差异无统计学意义(P>0.05)。时间与方法在面部表情、上肢、呼吸机顺应性评分上存在交互作用(P<0.05);时间在面部表情、上肢、呼吸机顺应性评分上主效应显著(P<0.05);方法在面部表情、上肢、呼吸机顺应性评分上主效应显著(P<0.05);观察患者用药后面部表情、上肢、呼吸机顺应性评分均低于对照组(P<0.05)。时间与方法在HR、MAP、SpO_2上存在交互作用(P<0.05);时间在HR、MAP、SpO_2上主效应显著(P<0.05);方法在HR、MAP、SpO_2上主效应显著(P<0.05);观察组患者用药后HR、MAP低于对照组,SpO_2高于对照组(P<0.05)。观察组患者谵妄、呕吐、恶心及瘙痒不良反应发生率均低于对照组(P<0.05)。结论舒芬太尼联合右美托咪定对ICU机械通气患者的镇痛效果较好,有利于更好地维持患者生命体征平稳,且安全性较高。
Objective To observe the effect of sufentanil combined with dexmedetomidine in patients with mechanical ventilation in intensive care unit (ICU). Methods From September 2013 to September 2015, 106 patients with mechanical ventilation in ICU of Yancheng Third People’s Hospital were randomly divided into control group and observation group with 53 cases in each group. After induction of conventional anesthesia, patients in the control group received continuous intravenous sufentanil and midazolam, and patients in the observation group received continuous intravenous sufentanil and dexmedetomidine. The Riker sedation and agitation score (SAS) at 1, 12, 24 h after treatment were compared between the two groups. The scores of pain behavior at 6, 12, 24 h and extubation pain score (BPS) , 24 h and post-extubation vital signs (including heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO_2)]; adverse reactions. Results There was no significant difference in SAS score between the two groups (P> 0.05). The main effect of time on SAS score was not significant (P> 0.05). The main effect of SAS score was not significant (P> 0.05) SAS scores at different time points, the difference was not statistically significant (P> 0.05). There was interaction between facial expression, upper extremity and ventilator compliance score (P <0.05). The main effect of time on facial expression, upper limbs and ventilator compliance score was significant (P <0.05) (P <0.05). The scores of facial expression, upper limbs and ventilator compliance of the upper limbs and ventilator were lower than those of the control group (P <0.05). The time and method had interaction on HR, MAP and SpO_2 (P <0.05). The main effect of time on HR, MAP and SpO_2 was significant (P <0.05), and the main effect was on HR, MAP and SpO 2 (P < 0.05). HR, MAP in the observation group were lower than those in the control group, SpO_2 was higher than that in the control group (P <0.05). The incidences of delirium, vomiting, nausea and itching in the observation group were lower than those in the control group (P <0.05). Conclusion Sufentanil combined with dexmedetomidine has a better analgesic effect on ICU patients with mechanical ventilation and is better for maintaining stable vital signs and higher safety.