布托啡诺联合舒芬太尼对ICU机械通气患者血流动力学及镇痛效果的影响

doi:10.3969/j.issn.1000-8535.2024.02.011

摘要/Abstract

摘要： 目的观察布托啡诺联合舒芬太尼镇痛方案在重症监护病房（ICU）机械通气患者中的效果及对血流动力学的影响。方法采用前瞻性、随机对照研究,选取2021年3月—2023年3月商丘市第三人民医院ICU收治的118例机械通气患者,按1∶1随机分为观察组、对照组各59例。观察组采取布托啡诺联合舒芬太尼镇痛方案,对照组采取舒芬太尼镇痛方案。比较两组镇静、镇痛情况（镇静起效时间、停药后苏醒时间、机械通气时间、ICU住院时间、丙泊酚总用量）。以用药前（T0）、用药后6 h（T1）、12 h（T2）、24 h（T3）为时间节点,比较两组血流动力学指标[心率（HR）、平均动脉压（MAP）]。以用药后6 h（t1）、12 h（t2）、18 h（t3）、24 h（t4）为时间节点,比较两组Ricker镇静-躁动评分（SAS）、重症监护疼痛观察工具（CPOT）评分。比较两组不良反应发生情况。结果用药后观察组镇静起效、停药后苏醒、机械通气、ICU住院时间均短于对照组,丙泊酚总用量少于对照组（P<0.05）;t1~t4时观察组CPOT评分均低于对照组,SAS评分均高于对照组（P<0.05）;T1、T2、T3时观察组HR、MAP波动幅度小于对照组（P<0.05）;观察组不良反应总发生率为10.17%,与对照组15.25%相比,差异无统计学意义（P>0.05）。结论布托啡诺、舒芬太尼联合治疗ICU机械通气患者,可有效增强镇静、镇痛效果,维持血流动力学稳定,且安全性较高,有利于促进患者病情转归。

关键词: 布托啡诺, 舒芬太尼, 重症监护病房, 机械通气, 血流动力学, 镇痛

Abstract: Objective To observe the effect of butorphanol and sufentanil combined analgesia regimen in patients with mechanical ventilation in intensive care unit（ICU）and its influence on hemodynamics．Methods A prospective,randomized controlled study was carried out on 118 patients with mechanical ventilation in ICU from March 2021 to March 2023,and the enrolled patients were randomly divided into observation group and control group with 59 cases in each group．The observation group received butorphanol combined with sufentanil analgesia regimen,and the control group received sufentanil analgesia regimen．The conditions of sedation and analgesia（sedation onset time,recovery time after drug withdrawal,mechanical ventilation time,ICU stay length,total dosage of propofol）were compared between the two groups．The hemodynamic indexes [heart rate（HR）and mean arterial pressure（MAP）] of the two groups were compared before medication（T0）,6 h（T1）,12 h（T2）and 24 h（T3）after medication as time nodes．At 6 h（t1）,12 h（t2）,18 h（t3）,24 h（t4）after medication,Ricker Sedation-Agitation Scale（SAS）and Critical Care Pain Observation Tool（CPOT）score were compared between the two groups．The occurrence of adverse reactions was compared between the two groups．Results The onset of sedation,recovery after drug withdrawal,mechanical ventilation and ICU stay in the observation group were shorter than those in the control group,and the total dosage of propofol was lower than that in the control group（P<0.05）．At t1 to t4,CPOT score of observation group was lower than that of control group,and SAS score was higher than that of control group（P<0.05）．The fluctuation amplitude of HR and MAP in the observation group was smaller than that in the control group at T1,T2 and T3（P<0.05）．The total incidence of adverse reactions in the observation group was 10.17%,compared with 15.25% in the control group,the difference was not statistically significant（P>0.05）．Conclusions The combination of butorphanol and sufentanil in the treatment of patients with mechanical ventilation in ICU can effectively enhance sedation and analgesia,maintain hemodynamic stability,and have high safety,which is conducive to promote the outcome of the disease．

Key words: butorphanol, sufentanil, ICU, mechanical ventilation, hemodynamics, relieve pain

赵一菡, 李艳华, 陈晶晶. 布托啡诺联合舒芬太尼对ICU机械通气患者血流动力学及镇痛效果的影响[J]. 广州医药, 2024, 55(2): 164-169.

ZHAO Yihan, LI Yanhua, CHEN Jingjing. Effects of butorphanol combined with sufentanil on hemodynamics and analgesia in patients with mechanical ventilation in ICU[J]. Guangzhou Medical Journal, 2024, 55(2): 164-169.

参考文献

[1] 郭华,王婷婷,耿宝,等.右美托咪定对新生儿机械通气患者血流动力学参数及应激反应的影响[J].川北医学院学报,2022,37(11):1455-1458.
[2] 鲁柏涛,康凯,郜杨,等.右美托咪定和丙泊酚对ICU内接受有创机械通气的腹部外科术后患者应激反应的影响[J].中国中西医结合急救杂志,2021,28(3):280-283.
[3] 王翠,马静,王笑,等.布托啡诺与舒芬太尼复合丙泊酚用于无痛肠镜中的效果研究[J].中国内镜杂志,2023,29(5):20-26.
[4] 余倩,杨富,方芳.危重症患者疼痛观察工具的研究进展[J].解放军护理杂志,2021,38(8):72-74.
[5] 张滢,王超昌,蒿梦潇,等.葡萄糖酸钙联合新斯的明对肥胖患者胃减容术后肌松恢复的影响[J].实用药物与临床,2022,25(10):870-874.
[6] 闫雁,孙建新,秦延军,等.纳布啡对ICU非机械通气患者的镇痛效果及安全性分析[J].河北医药,2021,43(3):340-344.
[7] 吴菊红,彭蒙蒙,邢颍.右美托咪定联合布托啡诺对机械通气患者肺内分流的影响及镇痛、镇静作用[J].检验医学与临床,2023,20(5):695-698.
[8] 韦炳耐,马凯宇,旷昕,等.纳布啡与舒芬太尼复合丙泊酚麻醉诱导对宫腔镜手术患者脑电双频指数及麻醉复苏影响[J].中国计划生育学杂志,2023,31(3):570-574.
[9] 张明杰,李悦娴,孙德峰.酒石酸布托啡诺镇痛应用进展[J].实用医学杂志,2022,38(14):1842-1846.
[10] 贾红炜. 布托啡诺和芬太尼对有创机械通气患者的镇痛效果及预后比较[D].唐山:华北理工大学,2021.
[11] 何细飞,辜莹,杨伟梅,等.舒芬太尼对心房颤动射频消融术患者的镇静和镇痛效果更优于芬太尼[J].内科急危重症杂志,2021,27(6):497-500.
[12] 隆雨秋,张莉,陈均,等.右美托咪定联合舒芬太尼对体外循环下心脏瓣膜置换术患者血流动力学的影响及心肺功能的保护作用研究[J].实用心脑肺血管病杂志,2021,29(7):80-85.
[13] 赵竞余,姜丽杰,贾庆成,等.酒石酸布托啡诺对冠状动脉旁路移植术丙泊酚麻醉诱导期血流动力学的影响[J].局解手术学杂志,2023,32(4):346-350.
[14] 李晓青,曹雪鹏,朱伟超,等.布托啡诺超前镇痛对肺癌患者胸腔镜肺叶切除术围术期应激反应及术后疼痛的影响[J].肿瘤研究与临床,2021,33(1):28-32.
[15] 雷鸣,唐作垒,李文忠,等.右美托咪定联合舒芬太尼对肺癌胸腔镜手术血流动力学及不良反应的影响[J].成都医学院学报,2021,16(3):311-314.