舒芬太尼联合右美托咪定对Ⅱ型呼吸衰竭 机械通气患者镇痛镇静效果研究

Effect of Sufentanil combined with Dexmedetomidine on analgesia and sedation in mechanically-ventilated patients with type II respiratory failure

摘要:

目的 研究舒芬太尼联合右美托咪定用于Ⅱ型呼吸衰竭机械通气患者早期目标导向性镇痛镇静的 临床方法。方法 选取2015 年7 月-2017 年6 月四川绵阳四O 四医院Ⅱ型呼吸衰竭患者90 例，采用随机数 字表法分为对照组（芬太尼联合咪达唑仑方案）和观察组（舒芬太尼联合右美托咪定镇痛镇静方案），每组各 45 例。镇痛目标CPOT ≤ 2，镇静目标RASS 在-2 ～ 1 范围。比较两组患者带机时间、血压减低、呼吸抑 制、谵妄发生、唤醒时间、ICU 住院时间、炎症因子水平方面的指标。结果 两组在达到镇静目标所需时间 差异无统计学意义（P >0.05）；两组在达到镇痛目标所需时间差异有统计学意义（P <0.05）；唤醒时间方面， 观察组与对照组比较，差异有统计学意义（P <0.05）；前者更容易唤醒；观察组机械通气时间与对照组比较， 差异有统计学意义（P <0.05），观察组机械通气时间短于对照组；观察组谵妄和呼吸抑制发生率低于对照组 （P <0.05）；观察组血压减低发生率低于对照组（P <0.05）；两组患者镇静24 h 时血浆TNF-α 水平比较差异 无统计学意义（P >0.05）。观察组患者镇静24 h 时血浆IL-1 水平较对照组低（P <0.05）。结论 Ⅱ型呼吸衰 竭患者施行早期目标导向镇静是可行的，镇静效果满意，可缩短ICU 住院及机械通气时间，呼吸循环影响较小， 谵妄发生较少。

Abstract:

Objective To study the clinical efficacy of Sufentanil combined with Dexmedetomidine in the treatment of type II respiratory failure in the patients with mechanical ventilation. Methods Ninety patients with type II respiratory failure in Sichuan Mianyang 404 Hospital from July 2015 to June 2017 were randomly divided into a control group (Sufentanil combined with Midazolam routine analgesia regimen) and an observation group (Sufentanil combined with Dexmedetomidine sedation regimen), with 45 cases in each group. The analgesic goal was CPOT (Critical-care Pain Observation Tool) ≤ 2, and the sedation target was RASS (Richmond Agitation-Sedation Scale) ranging from -2 to 1. The two groups were compared in terms of time, blood pressure, respiratory depression, occurrence of delirium, wake-up time, ICU hospitalization time, and inflammatory factors. Results There was no significant difference in the time required to reach the goal of sedation between the two groups (P > 0.05), while the time required to reach the target of analgesia had a significant difference between the two groups (P < 0.05). There was a significant difference in the wake-up time between the observation group and the control group (P < 0.05), the patients in the observation group were more likely to wake up. The mechanical ventilation time in the observation group was shorter than that in the control group (P < 0.05), the incidences of delirium and respiratory depression in the observation group were lower than those in the control group, the differences were significant (P < 0.05). The incidence of blood pressure lowering in the observation group was lower than that in the control group (P < 0.05). There was no significant difference in plasma TNF-α level between the two groups at the 24th h of sedation (P > 0.05). The level of plasma IL-1 in the observation group was lower than that of the control group at the 24th h of sedation (P < 0.05). Conclusions Early goal-directed sedation is feasible in the patients with type II respiratory failure, and the sedative effect is satisfactory. It can shorten the time of ICU hospitalization and mechanical ventilation, and only has a little effect on respiration and circulation, and low occurrence of delirium.