瑞马唑仑联合瑞芬太尼用于老年心功能不全患者的镇静镇痛的效果研究

Effects of remimazolam combined with remifentanil on sedation and analgesia in elderly patients with cardiac insufficiency

中文关键词: 老年  心功能不全  瑞马唑仑  丙泊酚  镇静镇痛

英文关键词: elderly  cardiac insufficiency  remimazolam  propofol  sedation  analgesia

中文摘要:

      目的 观察瑞马唑仑联合瑞芬太尼在老年心功能不全重症病房患者中的镇静镇痛效果.方法 选择2022年12月—2023年12月于眉山市第二人民医院就诊的196例重症病房内心功能不全并接受呼吸机辅助呼吸的老年患者,根据所采取镇静镇痛方案的不同分为2组,丙泊酚组(109例)采用丙泊酚联合瑞芬太尼的镇静镇痛方案,瑞马唑仑组(87例)采用瑞马唑仑联合瑞芬太尼的镇静镇痛方案.比较2组浅镇静达标时间、达标率、血流动力学指标监测、机械通气时间和住院时间.结果 瑞马唑仑组的浅镇静达标时间比丙泊酚组起效快[(23.4±5.7)min vs(31.6±4.6)min,P＜0.05];浅镇静达标率高于丙泊酚组(72.6％vs 44.5％,P＜0.05);瑞马唑仑组血压、心动过缓、乳酸升高、中心静脉压增加和升压药用量增加的发生率低于丙泊酚组(19.5％vs 32.1％,P＜0.05;17.2％vs 22.0％,P＜0.05;14.9％vs 22.9％,P＜0.05;4.6％vs 20.2％,P＜0.05;6.9％vs 28.4％,P＜0.05).瑞马唑仑组的机械通气时间和住院时间低于丙泊酚组(5.0 d vs9.0 d,P＜0.05;11.0 d vs 16.0 d,P＜0.05).结论 相较于丙泊酚联合瑞芬太尼,瑞马唑仑联合瑞芬太尼用于重症病房内老年心功能不全患者的起效时间缩短,镇静深度可控性升高,血流动力学更为稳定,呼吸机时间和住院时间缩短.

英文摘要:

      Objective To investigate the sedative and analgesic effects of remimazolam combined with remifentanil on elderly patients with cardiac insufficiency in Intensive Care Unit.Methods A total of 196 elderly patients with cardiac insuffi-ciency who received ventilator-assisted breathing and admitted to Second People's Hospital of Meishan City from December 2022 to December 2023 were selected.According to the different sedation and analgesia regimens adopted,they were divided into two groups:propofol group(109 cases,adopted the sedation and analgesia regimen of propofol combined with remifen-tanil)and remimazolam group(87 cases,adopted the sedation and analgesia regimen of remimazolam combined with remifen-tanil).The shallow sedation compliance time and compliance rate,hemodynamic monitoring indicators,mechanical ventilation time and hospitalization time of the two groups were compared.Results The shallow sedation compliance time in the remima-zolam group was faster than that in the propofol group[(23.4±5.7)min vs(31.6±4.6)min,P＜0.05],and the shallow sedation compliance rate was higher than that in the propofol group(72.6％vs 44.5％,P＜0.05).The incidence of hypoten-sion,bradycardia,elevated lactate,increased central venous pressure and increased dosage of pressor agent in the remimazolam group were lower than those in the propofol group(19.5％vs 32.1％,P＜0.05;17.2％vs 22.0％,P＜0.05;14.9％vs 22.9％,P＜0.05;4.6％vs 20.2％,P＜0.05;6.9％vs 28.4％,P＜0.05).The mechanical ventilation time and hospitali-zation time in the remimazolam group were shorter than those in the propofol group(5.0 d vs9.0 d,P＜0.05;11.0 d vs 16.0d,P＜0.05).Conclusion Compared with propofol combined with remifentanil,remimazolam combined with remifen-tanil in elderly patients with cardiac insufficiency in Intensive Care Unit can better shorten the onset time,and increase the con-trollability of sedation depth.It has more stable hemodynamics and can shorten the mechanical ventilation time and hospitaliza-tion time.