丙泊酚联合瑞芬太尼对机械通气患者镇痛镇静效果.docVIP

丙泊酚联合瑞芬太尼对机械通气患者镇痛镇静效果 　　【摘要】 目的 比较三组镇痛镇静药物对机械通气患者的镇痛镇静效果，以探讨满意的镇痛镇静方法。方法 60例行机械通气需镇痛镇静治疗的危重患者随机均分为三组，每组20例。咪达唑仑+芬太尼组（MF组）：静注咪达唑仑0.1mg.kg－1+芬太尼1μg.kg－1后，持续微泵输注咪达唑仑0.04mg.kg－1.h－1，芬太尼0.6μg.kg－1.h－1；丙泊酚+芬太尼组（PF组）：静注丙泊酚1.5mg.kg－1+芬太尼1μg.kg－1后, 持续泵注丙泊酚1.5 mg.kg－1.h－1，芬太尼0.6μg.kg－1.h－1；丙泊酚+瑞芬太尼组（PR组）：静注丙泊酚1.5mg.kg－1+瑞芬太尼0.1μg.kg－1后，持续泵注丙泊酚1.5mg.kg－1.h－1，瑞芬太尼0.8μg.kg－1.h－1。记录3组患者在治疗后第24h、48h、72h、96h等各时间点镇痛、镇静评分，各组出现的躁动、谵妄、人机对抗等不良反应，观察停药后达到唤醒标准的等待时间。结果 三组患者镇痛效果均满意，无统计学意义。PF组、PR组镇静效果优于MF组。唤醒等待时间上，PR组等待时间少于PF、MF组。不良反应发生率MF组明显高于PF组、PR组。结论 丙泊酚联合瑞芬太尼泵注对危重患者机械通气疗效好，镇静满意，唤醒时间短，不良反应低，可控性最佳。 　　【关键词】 镇痛镇静 咪达唑仑 丙泊酚 瑞芬太尼 每日唤醒 　　中图分类号：R971.1 文献标识码：A 文章编号：1005-0515（2011）5-034-03 　　The effects of sedation and analgesia of propofol combined with remifentanil in patients on mechanical ventilation 　　ZHU Yun-xiang, WU Fu-li, JU Sen, et al. 　　(Department of ICU,Guangyuan central hospital, Guangyuan,Sichuan 628000) 　　【Abstract】Objective Compared the effect of sedation and analgesia in mechanical ventilation with three sedation drugs in order to explore the satisfaction of sedation method.Methods Sixty critically ill patients scheduled for mechanical ventilation were randomly allocated into three groups according to the different sedation methods: intravenous midazolam 0.1mg/kg + fentanyl 1μg/kg, then continuous micro-infusion of midazolam0.04mg.kg－1.h－1 and fentanyl 0.6μg.kg－1.h－1(group MF,n=20); intravenous propofol 1.5mg/kg + fentanyl 1μg/kg, then continuous micro-infusion of propofol 1.5mg.kg－1.h－1 and fentanyl 0.6μg.kg－1.h－1(group PF,n=20);and intravenous propofol 1.5mg/kg + remifentanil0.1μg/kg, then continuous micro-infusion of propofol 1.5mg.kg－1.h－1 and remifentanil 0.8μg.kg－1.h－1(group PR,n=20). Numeric rating scales（NRS）, Ramsay scales，side-effects including Agitation, delirium, human confrontation were assessed after the 24th,48th,72th and 96th hour of treatment. The time was recordedafter stopping to wait for standards to wake up. Results There were no significant of NRS sc