异丙酚联合瑞芬太尼在多发伤机械通气中的镇静镇痛效果

目的探讨异丙酚联合瑞芬太尼在多发伤机械通气患者中的镇静镇痛效果及护理。方法选择ICU接受气管插管机械通气的多发伤患者40例，随机均分成2组：观察组在上机后给予异丙酚诱导后，再行异丙酚联合瑞芬太尼微量注射泵泵入；对照组单纯给予异丙酚诱导后再微量注射泵输入。用药后5min，15min，2h后监测平均动脉压（MAP）、心率（HR）、呼吸（R）、脉搏血氧饱和度（SpO2）变化，并观察2组镇静效果、异丙酚总用量、机械通气时间、在ICU住院时间。结果2组的生命体征在用药后5min、15min差异无统计学意义（均P〉0．05），观察组用药后2h的MAP、HR、R均低于对照组（均P〈0．05）。观察组的异丙酚总用量（P〈0．01）、机械通气时间（P〈0．01）、在ICU住院时间（P〈0．05）均明显少于对照组。结论异丙酚联合瑞芬太尼用于多发伤患者机械通气过程中能达到有效的镇静镇痛状态，便于控制镇静深度，减少异丙酚总用量、有利于呼吸机撤离，减少机械通气时间和在ICU住院时间。

Sedative and analgesic effects of propofol with remifentanil in mechanical ventilation for patients with multiple traumas

Objective To investigate the sedative and analgesic effects and of propofol and remifentanil on the patients with multiple trauma during mechanical ventilation. Methods Forty patients with multiple trauma undergoing tracheal intubation and mechanical ventilation were randomly divided into two equal groups： experimental group in which anesthesia was induced by propofol, and maintained with propofol and remifentanil using micro-injection pump, and control group in which anesthesia was induced by propofol, and maintained with propofol. Mean arterial pressure （MAP）, heart rate （HR）, and respiration rate （RR） were monitored 5 min, 15 min, and 2h after the beginning of medication. The sedative effect, dosage of propofol, duration of mechanical ventilation, and time of hospitalization in ICU were observed and compared between these 2 groups. Results There were not significant differences in the vital signs 5 minutes and 15 minutes after the beginning of medication between these 2 groups （all P〉0.05）, However, the MAP, HR, and RR levels 2h later of the experimental group were all significantly lower than those of the observation group （all P〈0.05）. In comparison with the observation group, the dosage of propofol of the experimental group was less, the duration of mechanical ventilation and time of hospitalization in ICU were shorter （P〈O.O1 or P〈O.05）. Conclusion With lower dosage of propofol, shorter duration of mechanical ventilation and time of hospitalization in ICU, propofol combined with remifentanil used during mechanical ventilation in treatment of the patients with multiple traumas achieves effective results of sedation and analgesia.