瑞芬太尼用于ICU术后患者镇痛安全性和有效性的临床观察

目的评价持续静脉输注7种不同剂量的瑞芬太尼用于重症监护病房（ICU）患者术后镇痛的安全性和有效性.方法纳入70例ICU患者,随机分为7组（A1～A7）,分别以0.02～0.08μg/（kg.min）持续静脉输注瑞芬太尼30 min;观察各组患者在给药前、给药后10 min、20 min和30 min的循环呼吸参数,判定给药前、给药后30 min的镇痛评分和Ramsay镇静评分,记录给药期间发生的呼吸抑制等不良反应.结果与给药前比较,给药30 min后各组VAS镇痛评分降低（P〈0.05）;与A1和A2组相比,A6和A7组VAS镇痛评分下降幅度（△VAS评分）较大（P〈0.01）.与给药前比较,给药30 min后各组Ramsay镇静评分均升高（P〈0.05）;A2～A6组间Ramsay镇静评分升高幅度（△Ramsay评分）无明显差异.术后镇痛期间有3组发生心率慢、呼吸抑制（RR〈8次/min）和低氧血症（SpO2〈90%）,共4例.结论瑞芬太尼0.05μg/（kg.min）用于SICU患者的术后镇痛时,VAS镇痛评分和Ramsay镇静评分均较低,亦无呼吸抑制发生,是较适宜的剂量.

Clinical Observation of Remifentanil for Postoperative Analgesia Safety and Efficacy in ICU Patients after Operation

Objective To evaluate the safety and efficacy of continuous infusion of 7 different doses of remifentanil in intensive care unit（ICU）patients.Methods 70 ICU patients were randomly divided into 7 groups（A1-A7）,and were continuously injected with 0.02～0.08 μg/（kg.min） of remifentanil for 30 min.The circulatory and respiratory parameters of patients in each group before administration,10 min,20 min and 30 min after administration were observed,the pain score and ramsay sedation score before administration and 30 min after administration were evaluated,the adverse reactions such as respiratory depression during the administration were recorded.Results Compared with before administration,VAS pain score in each group was decreased 30 min after administration（P0.05）.Compared with A1 and A2 group,the decrease range of VAS pain score（△VAS rates） in A6 and A7 group was higher（P0.01）.Compared with before administration,Ramsay sedation score 30 min after administration in each group were higher（P0.05）.There was no significant difference in the increase range of Ramsay sedation score（△Ramsay rates）among A2 ~ A6 group.The slow heart rate,respiratory depression（RR8 times/min）and hypoxemia（SpO290%）occurred in total 4 patients in 3 groups during postoperative analgesia.Conclusion 0.05 μg/（kg.min） of Remifentanil is an appropriate dose for postoperative analgesia in SICU patients,and has lower VAS pain score and Ramsay sedation score without respiratory depression