瑞芬太尼联合布托啡诺在机械通气患者中的应用效果及其对呼吸动力学的影响研究

背景目前,为了改善机械通气患者人机协调、保护患者脏器功能,临床上主要采取镇痛、镇静治疗。瑞芬太尼和布托啡诺联用可以减少药物相关不良反应,但二者用于机械通气患者的研究报道较少。目的探讨瑞芬太尼联合布托啡诺在机械通气患者中的应用效果及其对呼吸动力学的影响,以期为机械通气患者选取镇痛、镇静治疗方案提供参考。方法选取2018—2020年华中科技大学协和江北医院重症医学科收治的拟行机械通气的患者200例作为研究对象,采用随机数字表法分为研究组(n=100)和对照组(n=100)。对照组患者给予布托啡诺治疗,研究组患者在对照组基础上联合瑞芬太尼治疗。比较两组患者用药前、用药10 min、用药2 h呼吸动力学指标[气道阻力、动态肺顺应性(Cdyn)、平均气道压(Pmean)、吸气峰压(Ppeak)、自主呼吸频率、每分钟通气量(MV)、呼气潮气量(Vexp)、吸气潮气量(Vins)],用药6、12、18、24 h重症监护疼痛观察工具(CPOT)评分和Ramsay镇静评分,术后苏醒时间(包括拔管时间、睁眼时间、呼吸恢复时间)。结果用药前及用药2 h,两组患者气道阻力、Cdyn、Pmean、Ppeak、自主呼吸频率、MV、Vexp及Vins比较,差异无统计学意义(P>0.05);用药10 min,研究组患者气道阻力、Pmean、Ppeak、自主呼吸频率低于对照组,Cdyn、MV、Vexp及Vins高于对照组(P<0.05)。用药6、12、18、24 h,研究组患者CPOT评分和Ramsay镇静评分均低于对照组(P<0.05)。两组患者术后拔管时间、睁眼时间及呼吸恢复时间比较,差异无统计学意义(P>0.05)。结论瑞芬太尼联合布托啡诺能有效提高机械通气患者的镇痛、镇静效果,对呼吸动力学指标的影响小,且未延长患者术后苏醒时间。

Application Effect of Remifentanil Combined with Butorphanol in Patients with Mechanical Ventilation and Its Effect on Respiratory Dynamics

Background At present,in order to improve the man-machine coordination and protect the organ function of patients with mechanical ventilation,analgesia and sedation are mainly used in clinic.Remifentanil combined with butorphanol can reduce drug-related adverse reactions,but there are few reports on their use in patients with mechanical ventilation.Objective To investigate the application effect of remifentanil combined with butorphanol in patients with mechanical ventilation and its effect on respiratory dynamics,in order to provide reference for patients with mechanical ventilation to choose analgesic and sedative treatment.Methods A total of 200 patients to be treated with mechanical ventilation in the Department of Critical Medicine,Union Jiangbei Hospital,Huazhong University of Science and Technology from 2018 to 2020 were selected as the research objects.They were randomly divided into the study group(n=100)and the control group(n=100).Patients in the control group were treated with butorphanol,and patients in the study group were treated with remifentanil on the basis of the control group.The respiratory dynamic indexes[airway resistance,dynamic lung compliance(Cdyn),mean airway pressure(Pmean),peak inspiratory pressure(Ppeak),spontaneous respiratory rate,minute ventilation at rest(MV),expiratory tidal volume(Vexp),inspiratory tidal volume(Vins)]before medication,10 min after medication and 2 hours after medication,Critical-care Pain Observation Tool(CPOT)score and Ramsay sedation score at 6,12,18 and 24 hours after medication,and postoperative recovery time(including extubation time,eye opening time and respiratory recovery time)were compared between the two groups.Results There was no significant difference in airway resistance,Cdyn,Pmean,Ppeak,spontaneous respiratory rate,MV,Vexp and Vins between the two groups before medication and at 2 hours after medication(P>0.05);10 min after medication,the airway resistance,Pmean,Ppeak and spontaneous respiratory rate in the study group were lower than those in the control group,and Cdyn,MV,Vexp,Vins were higher than those in the control group(P<0.05).The CPOT score and Ramsay sedation score in the study group were lower than those in the control group at 6,12,18 and 24 hours after medication(P<0.05).There was no significant difference in extubation time,eye opening time and respiratory recovery time between the two groups(P>0.05).Conclusion Remifentanil combined with butorphanol can effectively improve the analgesic and sedative effects of patients with mechanical ventilation,and it has little effect on respiratory mechanical indexes,and do not prolong the postoperative recovery time.