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中国临床药理学与治疗学 ›› 2022, Vol. 27 ›› Issue (10): 1119-1124.doi: 10.12092/j.issn.1009-2501.2022.10.006

• 药物治疗学 • 上一篇    下一篇

瑞芬太尼在重型颅脑外伤患者术后ICU镇静镇痛中的应用

伍小霞,周虎   

  1. 长沙市中心医院重症医学科,长沙 410004,湖南
  • 收稿日期:2022-04-11 修回日期:2022-09-05 出版日期:2022-10-27 发布日期:2022-11-14
  • 通讯作者: 周虎,男,本科,副主任医师,研究脓毒症、镇痛镇静方面。 E-mail: xunle51847@163.com
  • 作者简介:伍小霞,女,硕士,主治医师,研究重症心脏、脓毒症方面。 E-mail: xunle51847@163.com

Application of remifentanil in postoperative ICU sedation and analgesia in patients with severe craniocerebral trauma

WU Xiaoxia, ZHOU Hu   

  1. Department of Critical Care, Changsha Central Hospital, Changsha 410004, Hunan, China
  • Received:2022-04-11 Revised:2022-09-05 Online:2022-10-27 Published:2022-11-14

摘要: 目的:探讨瑞芬太尼在重型颅脑外伤术后镇静镇痛管理中的效果及对动脉-颈内静脉血氧含量差(Da-jvO2)、静脉血氧含量(CjvO2)、炎症应激的影响。方法:选取2017年1月至2020年4月本院92例重型颅脑外伤手术患者作为研究对象,随机分组,各46例。两组均予以术后镇静镇痛管理,对照组给予右美托咪定治疗,观察组使用瑞芬太尼进行联合治疗。观察统计两组镇静镇痛效果、生命体征、炎症刺激[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)]相关指标、血清皮质醇、β-内啡肽及不良反应发生率。结果:观察组给药后2 h、4 h、12 h镇静镇痛评分低于对照组(P<0.05);观察组给药后6 h心率(HR)、平均动脉压(MAP)、呼吸频率(RR)低于对照组,给药后12 h平均动脉压、呼吸频率低于对照组(P<0.05);给药后6 h、12 h,观察组CRP、TNF-α、IL-6、IL-10、皮质醇水平低于对照组,CjvO2、β-内啡肽水平高于对照组(P<0.05);两组不良反应发生情况无明显差异(P>0.05)。结论:瑞芬太尼应用于重型颅脑外伤术后镇静镇痛管理中,可有效提高镇静镇痛效果,降低炎症刺激,调节皮质醇、β-内啡肽水平,值得临床推广应用。

关键词: 重型颅脑外伤, 镇静镇痛管理, 右美托咪定, 瑞芬太尼, 炎症应激

Abstract: AIM: To investigate the effect of remifentanil in the management of sedation and analgesia after severe traumatic brain injury and its influence on the incidence of inflammatory stress.  METHODS: From January 2017 to April 2020, 92 patients with severe head trauma surgery in our hospital were selected as the research objects, randomly divided into groups, each with 46 cases. Both groups received postoperative sedation and analgesia management, the control group received dexmedetomidine + 0.9%sodium chloride injection, and the observation group received dexmedetomidine combined with remifentanil. The effects of sedation and analgesia, vital signs, and inflammatory stimuli [C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10)] related indicators, serum cortisol, β-endorphin, and the incidence of adverse reactions in the two groups were observed and counted. RESULTS: The scores of sedation and analgesia in the observation group were lower than control group at 2 h, 4 h, and 12 h after administration (P<0.05). The heart rate, average arterial pressure, and respiratory rate of the observation group were lower than control group at 6 h after administration, and the average arterial pressure and respiratory rate at 12 h after administration were lower than those of the control group (P<0.05). At 6 h and 12 h after administration, the levels of CRP, TNF-α, IL-6, IL-10, and cortisol in the observation group were lower than control group, while the levels of β-endorphin were higher than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). CONCLUSION: Remifentanil is used in the management of sedation and analgesia after severe traumatic brain injury, which can effectively improve the effect of sedation and analgesia, reduce inflammatory stimulation, regulate the levels of cortisol, and β-endorphin  It is worthy of clinical application. 

Key words: severe craniocerebral trauma, sedation and analgesia management, dexmedetomidine, remifentanil, inflammatory stress

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