右美托咪啶与芬太尼联合对ICU腹部外科术后机械通气患者镇静镇痛的效果比较

目的:探讨右美托咪啶与芬太尼联合在ICU腹部外科术后机械通气患者中的应用效果及对镇静、镇痛作用的影响。方法:选择2018年5月-2019年6月ICU腹部外科术后机械通气患者62例,随机分为对照组(n=31例)和观察组(n=31例)。两组均采用芬太尼持续静脉泵入,对照组采用咪达唑仑镇静镇痛,观察组采用右美托咪啶镇静镇痛,比较两组镇痛镇静效果、镇静剂使用剂量、苏醒及达到镇静所需时间、血流动力学水平及安全性。结果:两组T2、T3时间点VAS评分分别为(2.40±0.31 vs 2.43±0.32和2.01±0.12 vs 2.05±0.15)、Ramsay量表评分分别(3.21±0.35 vs 3.20±0.33和3.01±0.25vs 3.00±0.24)均低于T1时间点(VAS评分2.94±0.69 vs 2.96±0.71;Ramsay量表评分3.57±0.61 vs 3.58±0.62)(P<0.05);观察组右美托咪啶联合芬太尼镇痛镇静达到镇静所需时间(34.29±3.56) min长于对照组(23.63±3.21)(t=5.535,P=0.043);观察组镇静剂使用剂量(220.59±15.25)μg、苏醒时间(3.29±0.69)min均少(短)于对照组镇静剂使用剂量(386.44±18.92)μg、苏醒时间(7.56±1.21)min(t=6.294、6.092,P=0.023、0.025);两组T1、T2时间点心率观察组T1(88.47±9.76)次/min、T2(86.41±9.43)次/min;对照组T1(89.53±10.41)次/min、T2(87.46±9.58)次/min]均高于T0时间点观察组(78.78±4.35)次/min、对照组(79.12±4.41)次/min](P<0.05);观察组T1、T2时间点MVP(79.58±5.71、87.53±6.76)mmHg高于对照组(74.12±4.69、75.26±5.61)mmHg(t=9.613、7.223,P=0.011、0.016);观察组的不良反应发生率为6.45%,与对照组的12.90%差异无统计学意义(χ~2=1.214, P=0.643)。结论:将右美托咪啶联合芬太尼用于ICU腹部外科术后机械通气患者中能获得良好的镇痛、镇静效果,缩短苏醒及达到镇静所需时间,血流动力学相对稳定,药物安全性较高,值得推广应用。

Comparison of Sedative and Analgesic Effects of Dexmedetomidine and Fentanyl on Patients withMechanical Ventilation After ICU Abdominal Surgery

Objective To explore the effect of dexmedetomidine combined with fentanyl in patients undergoing mechanical ventilation after abdominal surgery in ICU and its effect on sedation and analgesia.Methods From May 2018 to June 2019,62 patients with mechanical ventilation after abdominal surgery in ICU were selected as subjects and they were randomly divided into the control group(n=31 cases)and the observation group(n=31 cases).Both groups were received continuous intravenous pumping of fentanyl.The control group was used midazolam for sedation and analgesia and the observation group was used dexmedetomidine.The analgesic and sedative effects,sedative doses,time to achieve awakening and sedation,hemodynamic level and safety were compared.Results The VAS scores at time points of T2 and T3 in the two groups were(2.40±0.31 vs 2.43±0.32 and 2.01±0.12 vs 2.05±0.15),and the Ramsay scale scores(3.21±0.35 vs 3.20±0.33 and 3.01±0.25 vs.3.00±0.24)were lower than the time points of T1(VAS score:2.94±0.69 vs 2.96±0.71;Ramsay scale score:3.57±0.61 vs 3.58±0.62)(P<0.05);The time of dexmedetomidine combined with fentanylin to achieve sedation and analgesia in the observation group was longer(34.29±3.56 min)than that of the control group(23.63±3.21)(t=5.535,P=0.043).The dosage of sedatives(220.59±15.25μg)and the time to achieve awakening(3.29±0.69 min)in the observation group was shorter than those in the control group(386.44±18.92μg and 7.56±1.21 min)(t=6.294,6.092,P=0.023,0.025).The time snack rate of T2 and T2 in both groups(T1(88.47±9.76)times/min in observation group,T2(86.41±9.43)times/min in observation group;T1(89.53±10.41)times/min in control group,T2(87.46±9.58)times/min)were higher than that at time T0(observation group(78.78±4.35)times/min,control group(79.12±4.41)times/min)(P<0.05).The T1 and T2 time points MVP of the observation group(79.58±5.71,87.53±6.76mmHg)were higher than the control group(74.12±4.69,75.26±5.61 mmHg)(t=9.613,t=7.223,P=0.011,P=0.016).The incidence of adverse reactions during sedation and analgesia in the observation groups was 6.45%and in the control group was 12.90%,which was not statistically significant(χ^2=1.214,P=0.643).Conclusion Dexmedetomidine combined with fentanyl can provide good analgesic and sedative effects in patients who undergone mechanical ventilation after abdominal surgery in ICU.It can shorten the time to achieve awakening and sedation.The hemodynamics is relatively stable.It has high security and is worth promoting.