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瑞芬太尼应用于高血压脑出血术后镇痛镇静治疗的临床研究 预览

Clinical study of remifentanil in the treatment of postoperative analgesia and sedation after hypertensive intracerebral hemorrhage
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摘要 目的分析瑞芬太尼应用于脑出血术后镇痛镇静治疗的临床价值。方法将140例行开颅手术的高血压脑出血患者随机分为观察组、对照组各70例,对照组在术后予以芬太尼0.6~0.9μg/(kg·h)静脉泵入,观察组术后给予瑞芬太尼5~7.5μg/(kg·h)持续静脉泵入,效果不佳者均可联合丙泊酚静脉泵入,记录2组血压[收缩压(SBP)、舒张压(DBP)]变化及机械通气时间、入住ICU时间、再出血率,比较其重症监护疼痛观察量表(CPOT)、躁动-镇静评分(RASS)变化及不良反应发生率,采用美国国立卫生研究院量表(NIHSS)评估2组术后28 d及2个月、6个月神经功能。结果观察组术后4 h、8 h、16 h、24 h、48 h SBP、DBP均低于对照组(P均<0.05);观察组机械通气时间、入住ICU时间短于对照组,而再出血率低于对照组(P<0.05);观察组术后1 h、4 h、8 h、16 h、24 h CPOT评分、RASS评分均低于对照组(P均<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05);观察组术后28 d及2个月、6个月NIHSS评分均低于对照组(P均<0.05)。结论瑞芬太尼应用于高血压脑出血,可较好控制血压,并起到镇痛镇静、降低再出血率、缩短机械通气时间与入住ICU时间的作用,且安全可靠,有助于改善预后。 Objective It is to analyze the clinical value of remifentanil in the treatment of postoperative analgesia and sedation after cerebral hemorrhage.Methods A total of 140 patients with hypertensive intracerebral hemorrhage who underwent craniotomy were randomly divided into observation group and control group,70 cases in each group.The control group was given fentanyl 0.6-0.9μg/(kg·h)by intravenous pump.The observation group was given continuous intravenous infusion of remifentanil 5-7.5μg/(kg·h)by intravenous pump,the patients could given propofol by intravenous pumping if their pain were not well controlled.The changes of the blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP)]and mechanical ventilation time,ICU stay,rebleeding rate in both groups were recorded,the changes of critical care pain observation tool(CPOT),sedation-sedation score(RASS)and incidence of adverse reactions were compared,the neurological function at 28 days,2 and 6 months after surgery was evaluated by National Institute of Health Scale(NIHSS).Results The SBP and DBP at 4,8,16,24,48 hours after operation in the observation group were lower than those in the control group(P<0.05),the mechanical ventilation time and ICU stay in the observation group were shorter than that in the control group,and the rebleeding rate was lower than that of the control group(P<0.05).The CPOT scores and RASS scores of the observation group were lower than those of the control group at 1 h,4 h,8 h,16 h,and 24 h after operation(P<0.05);there was no significant difference in the incidence of adverse reaction between the two groups(P>0.05).The NIHSS scores in the observation group were lower than those of the control group at 28 days,2 months and 6 months after operation(P<0.05).Conclusion Remifentanil can well control blood pressure,reduce the rate of rebleeding,shorten the time of mechanical ventilation and the time of staying in ICU in the treatment of postoperative analgesia and sedation,and it is safe and reliable,and the prognosis is g
作者 杜晓敏 戴科芳 DU Xiaomin;DAI Kefang(The Third Hospital of Xingtai City,Xingtai 054000,Hebei,China;Institute of Cerebrovascular Disease of Xingtai City,Xingtai 054000,Hebei,China)
出处 《现代中西医结合杂志》 CAS 2019年第28期3105-3109,共5页 Modern Journal of Integrated Traditional Chinese and Western Medicine
基金 邢台市科技计划项目(2018ZC081)。
关键词 瑞芬太尼 脑出血 镇痛 镇静 remifentanil cerebral hemorrhage analgesia sedation
作者简介 杜晓敏,女,硕士,主治医师,研究方向为危重病患者的镇痛镇静治疗。
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