持续镇静镇痛联合纳洛酮治疗.doc

持续镇痛在急性呼吸窘迫综合征治疗中的作用 许月明，游波，冯春森，陈虎平（400020重庆，解放军第324医院心胸外科） [摘要] 目的 探讨持续镇静镇痛治疗严重胸外伤合并多发伤后急性呼吸窘迫综合征的可行性和安全性。方法：选取自2002年5月至2009年12月本科收治的严重胸部创伤合并多发伤患者ARDS 72例，其中21例采用我们自己配制的镇痛泵进行静脉持续镇痛镇静并配合使用纳洛酮治疗（Ⅰ组），28例行单纯持续镇静镇痛（Ⅱ组）、23例行间断镇痛镇静（Ⅲ组）。所有患者连续动态监测血压、心电图、心率（HR）、血氧饱和度（SaO2），均无明显CO2潴留（P＞0.05），但Paw、Pplat下降、OI升高、Vt及MVV在Ⅰ组改善最显著(P0.05)，Ⅰ组呼吸抑制、肺部感染、心功能不全以及心律失常等并发症均低其他两组（P＜0.05），但Ⅰ组、Ⅲ组出现烦躁、欣快等神经系统症状、恶心呕吐等胃肠道症状相似，且较Ⅱ组多（P＜0.05）。3组机械通气时间与ICU停留时间均以Ⅰ组最短。结论：持续镇静镇痛治疗严重胸外伤后急性呼吸窘迫综合征是安全有益的，联合纳洛酮有利于尽早脱离呼吸机。 [关键词] 胸外伤；急性呼吸窘迫综合征；纳洛酮；镇痛；镇静 Effection of Continuous sedation analgesia treatment in 21 cases of acut respiratory distress syndrome in severe chest trauma Xu Yueming, You Bo, Feng chunsen, Chen Huping (Department of Cardiothoracic Surgey, the 324 Hospital of PLA, Chongqing, 400020,China) [Abstract] Objective Our study was to approach the feasibility and safety of continuous sedation analgesia treatment of acut respiratory dysfunctional in severe chest trauma with multiple severe injuries．Method Continuous sedation analgesia associate with naloxone treatment of acute respiratory distress syndrome in 21 cases in our hospital ( Ⅰ group)，simple continuous sedation analgesia in 28 cases ( group), and 23 cases of intermittent analgesia and sedation(Ⅲ group) were analysed by contrasting．Result There were no significance among the three groups in injury severity score (ISS), acute physiology and chronicity health evaluation （APACHE ）score, arterial carbon dioxide partial pressureCO2）]，andoxygenation index（OI）, airway pressure（Paw）, spontaneous breathing tidal volume（Vt）．In each group after treatment, all indicators were improved and there were no significant carbon dioxide retention（＞0.05）. But Paw, plateau pressure(Pplat), OI increased, Vt and minute ventination volume (MVV)improved most significantly in I group, while repiratory depression, pulmonary infection, cardiac insufficiency and cardiac arrhythmia and other complications were lower to the other two groups. The irritability, eu