酒石酸布托啡诺在行有创机械通气高脂血症性重症急性胰腺炎患者中的应用

目的 观察酒石酸布托啡诺对行有创机械通气高脂血症性重症急性胰腺炎(HL-SAP)患者的镇痛、镇静效果.方法 行有创机械通气HL-SAP患者47例,数字抽签法随机分为治疗组23例和对照组24例,治疗组给予酒石酸布托啡诺联合舒芬太尼镇静、镇痛,对照组给予咪唑安定联合舒芬太尼镇静、镇痛.给予镇静、镇痛治疗4h、12 h、24 h、48 h时比较两组镇静评分(RASS评分)及镇痛评分(CPOT评分),比较两组患者的机械通气时间、ICU入住时间及谵妄发生率.结果 给予镇静、镇痛治疗4h、12h、24h、48 h时,两组RASS评分及CPOT评分比较均有统计学意义(P＜0.05),且均有随时间变化的趋势,分组与时间均有交互作用,治疗组优于对照组(P＜0.05);治疗组谵妄发生率为17.4％,低于对照组的45.8％ (P ＜0.05);治疗组患者入住ICU时间及机械通气时间均少于对照组(P＜0.05).结论 对行有创机械通气的HL-SAP患者,使用酒石酸布托啡诺联合舒芬太尼行镇静、镇痛治疗,可以明显改善镇静镇痛效果,减少谵妄的发生,缩短机械通气时间,应积极推广.

Application of butorphanol tartrate to hyperlipidemic severe acute pancreatitis patients undergoing invasive mechanical ventilation

Objective To observe the analgesic and sedative effect of butorphanol tartrate on hyperlipidemic severe acute pancreatitis (HL-SAP) patients undergoing invasive mechanical ventilation.Methods A total of 47 HL-SAP patients undergoing invasive mechanical ventilation were randomized into treatment group (23 cases) or control group (24 cases).Butorphanol tartrate and sufentanil were used for analgesia and sedation in the treatment group,while midazolam and sufentanil were used for analgesia and sedation in the control group.Richmond Agitation-Sedation Scale(RASS) sedation scores and Critical-Care Pain Observation Tool(CPOT) analgesia scores after 4,12,24 and 48 hours of sedation and analgesia were compared between the two groups,and duration of mechanical ventilation,ICU stay and incidence rate of delirium were compared as well.Results On the 4th,12th,24th and 48th hour after sedation and analgesia,RASS scores and CPOT scores showed significant differences between the two groups (P ＜ 0.05) and changed over time,there was an interaction between group and time,the scores in the treatment group were superior to those in the control group(P ＜ 0.05),and the incidence rate of delirium in the treatment group was significantly lower than that in the control group(17.4％ vs.45.8％,P ＜ 0.05).The treatment group had less ICU stay and less duration of mechanical ventilation compared with the control group (P ＜ 0.05).Conclusion For HL-SAP patients undergoing invasive mechanical ventilation,butorphanol tartrate in combination with sufentanil is safe and reliable when used for sedation and analgesia.It can significantly improve sedative and analgesic effect,reduce the incidence of delirium and the duration of mechanical ventilation,and thus its application should be actively promoted.