芬太尼對重癥監護病房機械通氣病人鎮靜效果的影響_《中國呼吸與危重監護雜志》

作者：

王希鋒 , 康焰 ,  劉進

四川大學華西醫院麻醉與危重醫學教研室（四川成都 610041）;

關鍵詞：

機械通氣鎮靜咪唑安定芬太尼

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目的觀察芬太尼對重癥監護病房行機械通氣的內科病人鎮靜效果的影響。方法 30例需機械通氣的內科病人隨機分為咪唑安定組（M組）和咪唑安定+芬太尼組（M+F組），每組15例。以肌肉活動評分法（MAAS）評分3分、ATICE人機順應性評分≥3分為鎮靜目標。記錄鎮靜前的血壓、心率、呼吸頻率、脈搏氧飽和度、氣道峰壓、吸入氧濃度、動脈氧分壓、MAAS評分、ATICE意識評分和人機順應性評分。鎮靜開始兩組均以咪唑安定0.05 mg/kg（每5分鐘靜脈推注一次），并進行鎮靜評估至達鎮靜目標。然后M組開始以咪唑安定0.1 mg?kg-1?h-1持續泵入；M+F組開始以咪唑安定+芬太尼混合液（100∶1）0.1 mL?kg-1?h-1持續泵入。每隔2 h進行一次鎮靜評估，調整藥物輸注速率維持鎮靜目標，記錄呼吸、循環及鎮靜指標。鎮靜中12 h和24 h各監測一次血氣分析，計算氧合指數。鎮靜達24 h時停止藥物輸注，每30 min評估一次鎮靜深度，記錄恢復時間（停藥至MAAS評分≥3分的時間）。計算藥物費用、藥物調整次數、鎮靜滿意程度和人機順應性滿意程度。結果鎮靜過程中兩組病人的血壓、氧合指數及藥物調整次數比較差異均無統計學意義（P gt;0.05）。M+F組的心率、氣道壓力、呼吸頻率、咪唑安定用量和藥物費用均明顯低于M組（P lt;0.05）；M+F組的脈搏氧飽和度高于M組（P lt;0.05）。M+F組的鎮靜滿意程度、人機順應性滿意程度和意識評分明顯高于M組，恢復時間較短（P lt;0.05）。結論對行機械通氣的內科病人使用芬太尼能提高咪唑安定的鎮靜效果，減少咪唑安定用量和藥物費用。

引用本文： 王希鋒,康焰,劉進. 芬太尼對重癥監護病房機械通氣病人鎮靜效果的影響. 中國呼吸與危重監護雜志, 2007, 6(1): 33-38. doi: 復制

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22.	van de Leur JP，van der Schans CP，Loef BG，et al.Discomfort and factual recollection in intensive care unit patients.Crit Care，2004，8：R467-R473.
23.	Brockmann C，Raasch W，Bastian C.Endocrine stress parameters during TIVA with remifentanil or sufentanil.Anasthesiol Intensivmed Notfallmed Schmerzther，2000，35：685-691.
24.	Mastronardi P，Cafiero T.Rational use of opioids.Minerva Anestesiol，2001，67：332-337.
25.	Breen D，Karabinis A，Malbrain M，et al.Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients：a randomised trial.Crit Care，2005，9：R200-R210.

1. Burchardi H.Aims of sedation/analgesia.Minerva-Anestesiol，2004，70：137-143.
2. Swaiss IG，Badran I.Discomfort，awareness and recall in the intensive care--still a problem? Middle East J Anesthesiol，2004，17：951-958.
3. Mallick A，Smith SN，Bodenham AR.Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation.Br J Anaesth，1996，77：731-734.
4. Guinsburg R，Kopelman BI，Anand KJ，et al.Physiological，hormonal，and behavioral responses to a single fentanyl dose in intubated and ventilated preterm neonates.J Pediatr，1998，132：954-959.
5. Dyke MP，Kohan R，Evans S.Morphine increases synchronous ventilation in preterm infants.J Paediatr Child Health，1995，31：176-179.
6. Katz R，Kelly HW.Pharmacokinetics of continuous infusions of fentanyl in critically ill children.Crit Care Med，1993，21：995-1000.
7. Irazuzta J，Pascucci R，Perlman N，et al.Effects of fentanyl administration on respiratory system compliance in infants.Crit Care Med，1993，21：1001-1004.
8. Schlunder C，Houben F，Hartwig S，et al.Analgesia and sedation in neonatal-pediatric intensive care.Klin Wochenschr，1991，69 Suppl 26：95-99.
9. Karabinis A，Mandragos K，Stergiopoulos S，et al.Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries：a randomised，controlled trial.Crit Care，2004，8：268-280.
10. Watson BD，Kane-Gill SL.Sedation assessment in critically ill adults：2001-2004 update.Ann Pharmacother，2004，38：1898-1906.
11. Gehlbach BK，Kress JP.Sedation in the intensive care unit.Curr Opin Crit Care，2002，8：290-298.
12. 孔靈菲，白曉昱，李振華，等.機械通氣配合鎮靜麻醉和肌松劑搶救重癥哮喘.中國呼吸與危重監護雜志，2002，1：43-44.
13. De Jonghe B，Cook D，Griffith L，et al.Adaptation to the Intensive Care Environment (ATICE)：development and validation of a new sedation assessment instrument.Crit Care Med，2003，31：2344-2354.
14. Muellejans B，Lopez A，Cross MH，et al.Remifentanil versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit：a randomized，double-blind controlled trial.Crit Care，2004，8：R1-R11.
15. Crocker C.Nurse led weaning from ventilatory and respiratory support.Intensive Crit Care Nurs，2002，18：272-279.
16. Ely EW.The utility of weaning protocols to expedite liberation from mechanical ventilation.Respir Care Clin N Am，2000，6：303-319.
17. Ely EW，Meade MO，Haponik EF，et al.Mechanical ventilator weaning protocols driven by nonphysician health-care professionals：evidence-based clinical practice guidelines.Chest，2001，120：454S-463S.
18. Jones C，Griffiths RD，Humphris G.Disturbed memory and amnesia related to intensive care.Memory，2000，8：79-94.
19. Jones C，Griffiths RD，Humphris G，et al.Memory，delusions，and the development of acute posttraumatic stress disorder-related syndromes after intensive care.Crit Care Med，2001，29：573-580.
20. Scragg P，Jones A，Fauvel N.Psychological problems following ICU treatment.Anaesthesia，2001，56：9-14.
21. Aldemir M，Ozen S，Kara IH，et al.Predisposing factors for delirium in the surgical intensive care unit.Crit Care，2001，5：265-270.
22. van de Leur JP，van der Schans CP，Loef BG，et al.Discomfort and factual recollection in intensive care unit patients.Crit Care，2004，8：R467-R473.
23. Brockmann C，Raasch W，Bastian C.Endocrine stress parameters during TIVA with remifentanil or sufentanil.Anasthesiol Intensivmed Notfallmed Schmerzther，2000，35：685-691.
24. Mastronardi P，Cafiero T.Rational use of opioids.Minerva Anestesiol，2001，67：332-337.
25. Breen D，Karabinis A，Malbrain M，et al.Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients：a randomised trial.Crit Care，2005，9：R200-R210.

《中國呼吸與危重監護雜志》

芬太尼對重癥監護病房機械通氣病人鎮靜效果的影響

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《中國呼吸與危重監護雜志》

芬太尼對重癥監護病房機械通氣病人鎮靜效果的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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