瑞芬太尼在重症监护病房机械通气患者中的应用效果

doi:10.3760/cma.j.cn441417-20240820-05017

摘要/Abstract

摘要：

目的　探讨瑞芬太尼在重症监护病房机械通气患者中的应用效果。方法　纳入2021年1月至2023年12月榆林市第一医院重症监护病房收治的机械通气患者120例为研究对象，按随机数字表法分为A组和B组各60例。A组和B组男女比分别为33∶27、34∶26；年龄分别为（47.25±4.39）、（47.36±4.42）岁；急性生理学与慢性健康状况（APACHEⅡ）评分分别为（21.07±2.03）、（21.11±2.06）分。A组采用芬太尼静脉泵入给药，起始剂量为0.5 μg/（kg·h），根据患者具体情况给予0.7～1.5 μg/kg负荷剂量；B组采用瑞芬太尼，起始剂量为0.05 μg/（kg·min）。采用面部表情评分法（FPS）、Ramsay镇静评分法评估两组疼痛程度、镇静状态，每20 min一次。对镇静镇痛效果不达标者，单次增加0.25 μg/（kg·h）芬太尼或0.025 μg/（kg·min）瑞芬太尼，直至镇痛镇静效果满意。对于芬太尼剂量增加至1 μg/（kg·h）或瑞芬太尼剂量增加至0.1 μg/（kg·min）但镇静镇痛效果仍不达标者，给予丙泊酚静脉泵入，起始剂量0.5 μg/（kg·h），逐渐增加用药剂量至镇静镇痛效果满意。比较两组相关指标。采用χ²检验、独立样本t检验进行统计学分析。结果　用药前及用药后90 min，两组患者Ramsay镇静评分和FPS评分、平均动脉压（MAP）及心率（HR）水平差异均无统计学意义（均P>0.05）。用药后10 min和30 min，两组Ramsay镇静评分均较用药前升高，B组更高；FPS评分均较用药前降低，B组更低；MAP、HR水平均较用药前下降，但B组高于A组，差异均有统计学意义（均P<0.05）。B组机械通气时间、拔管时间及住院时间均短于A组［（63.13±3.63）h比（89.26±3.41）h、（93.86±6.33）h比（126.35±13.41）h、（12.05±3.27）d比（16.52±5.84）d］，差异均有统计学意义（均P<0.05）。B组不良反应总发生率略低于A组，差异无统计学意义（P>0.05）。结论　瑞芬太尼不仅可以降低重症监护病房机械通气患者的FPS评分，也能提高Ramsay镇静评分，还能保持MAP、HR相对稳定，有利于患者的快速恢复，具有较高安全性。

关键词:

重症监护病房, 机械通气, 瑞芬太尼, 芬太尼, 应用效果

Abstract:

Objective　To explore the effect of remifentanil in patients with mechanical ventilation in intensive care unit (ICU). Methods　A total of 120 patients with mechanical ventilation admitted to ICU of Yulin First Hospital from January 2021 to December 2023 were included in this study, and were divided into group A and group B with 60 cases in each group according to the random number table method. The male to female ratios in group A and group B were 33:27 and 34:26; their ages were (47.25±4.39) and (47.36±4.42) years old; their Acute Physiology and Chronic Health Evaluation (APACHEⅡ) scores were (21.07±2.03) and (21.11±2.06) points. In group A, fentanyl was injected intravenously with an initial dose of 0.5 μg/(kg·h), and a load dose of 0.7-1.5 μg/kg was given according to the patients' specific conditions; group B was given remifentanil at 0.05 μg/(kg·min). The Face Pain Scale (FPS) and Ramsay sedation score were used to evaluate the pain degree and sedation state of the two groups every 20 min. For patients whose sedative and analgesic effect did not meet the requirements, 0.25 μg/(kg·h) of fentanyl or 0.025 μg/(kg·min) of remifentanil was added a single time until the analgesic and sedative effect was satisfactory. For patients whose fentanyl dose was increased to 1 μg/(kg·h) or remifentanil dose was increased to 0.1 μg/(kg·min) but the sedative and analgesic effect still did not meet the standard, propofol was given intravenously with the initial dose of 0.5 μg/(kg·h), and the dosage was gradually increased until the sedative and analgesic effect was satisfactory. The relevant indicators of the two groups were compared. χ² test and independent sample t test were used for statistical analysis. Results　There were no statistically significant differences in the Ramsay sedation score, FPS score, mean arterial pressure (MAP), or heart rate (HR) between the two groups before and 90 min after medication (all P>0.05). At 10 and 30 min after medication, the Ramsay sedation score s of both groups were higher than those before medication, and the score in group B was even higher; the FPS scores were lower than those before medication, and the score in group B was even lower; the MAP and HR of both groups were lower than those before medication, but those in group B were higher than those in group A, with statistically significant differences (all P<0.05). The mechanical ventilation time, extubation time, and hospital stay in group B were shorter than those in group A [(63.13±3.63) h vs. (89.26±3.41) h, (93.86±6.33) h vs. (126.35±13.41) h, (12.05±3.27) d vs. (16.52±5.84) d], with statistically significant differences (all P<0.05). The total incidence of adverse reactions in group B was slightly lower than that in group A, with no statistically significant difference (P>0.05). Conclusion　For ICU patients with mechanical ventilation, remifentanil can reduce the FPS score, effectively improve the Ramsay sedation score, and keep the MAP and HR levels relatively stable, which is conducive to the patients' rapid recovery , with high safety.

Key words:

Intensive care unit, Mechanical ventilation, Remifentanil, Fentanyl, Application effect

张利佳张如李瑞涛陈婷.

瑞芬太尼在重症监护病房机械通气患者中的应用效果 [J]. 国际医药卫生导报, 2025, 31(5): 787-791.

Zhang Lijia, Zhang Ru, Li Ruitao, Chen Ting.

Effect of remifentanil in patients with mechanical ventilation in intensive care unit [J]. International Medicine and Health Guidance News, 2025, 31(5): 787-791.

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