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不同年龄段患者入住重症监护病房时纳布啡和舒芬太尼的疼痛管理。

Pain management of nalbuphine and sufentanil in patients admitted intensive care unit of different ages.

机构信息

Department of Critical Care Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Shenyang, China.

出版信息

BMC Emerg Med. 2022 Mar 26;22(1):50. doi: 10.1186/s12873-022-00592-x.

Abstract

BACKGROUND

Pain relief for patients in the intensive care unit (ICU) can improve treatment outcomes and reduce the burden on doctors and nurses. This study aims to report the clinical analgesic and sedative effects of nalbuphine and sufentanil on ICU patients.

METHODS

This study retrospectively analyzed the medical records of 87 critically ill patients who received nalbuphine or sufentanil infusion in the ICU, including demographic data, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II, Critical Care Pain Observation Tool (CPOT), Richmond Agitation-Sedation Scale (RASS), systolic and diastolic blood pressure, heart rate and blood oxygen saturation (SpO). The primary outcomes of this study were CPOT and RASS scores. The secondary outcomes were hemodynamic changes, including systolic blood pressure, diastolic blood pressure, heart rate, and SpO2. The adverse events recorded during pain management, such as hypoxemia, respiration depression and bradycardia, were also collected and analyzed.

RESULTS

None of the patients in both groups experienced episode of hypoxemia, respiration depression and bradycardia. However, age-stratified analyses showed that nalbuphine has a better analgesic effect than sufentanil for patients aged ≤ 60 (P < 0.05). In contrast, sufentanil showed a better analgesic effect than nalbuphine for patients aged > 60 ( P < 0.05). Furthermore, nalbuphine has a significantly better sedative effect than sufentanil for patients aged ≤ 60 (P < 0.05).

CONCLUSION

ICU patients of different age groups may be suitable for different analgesics. For patients under the age of 60, nalbuphine has better analgesia and sedation than sufentanil, and does not cause respiratory depression and drastic hemodynamic changes.

摘要

背景

为重症监护病房(ICU)患者提供止痛可改善治疗效果并减轻医生和护士的负担。本研究旨在报告纳布啡和舒芬太尼在 ICU 患者中的临床镇痛和镇静效果。

方法

本研究回顾性分析了在 ICU 接受纳布啡或舒芬太尼输注的 87 例危重症患者的病历,包括人口统计学数据、诊断、急性生理学和慢性健康评估(APACHE)Ⅱ评分、重症监护疼痛观察工具(CPOT)评分、Richmond 躁动-镇静评分(RASS)、收缩压和舒张压、心率和血氧饱和度(SpO2)。本研究的主要结局为 CPOT 和 RASS 评分。次要结局为血流动力学变化,包括收缩压、舒张压、心率和 SpO2。还收集并分析了疼痛管理过程中记录的不良反应,如低氧血症、呼吸抑制和心动过缓。

结果

两组患者均未发生低氧血症、呼吸抑制和心动过缓。然而,年龄分层分析显示,纳布啡在年龄≤60 岁的患者中的镇痛效果优于舒芬太尼(P<0.05)。相比之下,舒芬太尼在年龄>60 岁的患者中的镇痛效果优于纳布啡(P<0.05)。此外,纳布啡在年龄≤60 岁的患者中的镇静效果明显优于舒芬太尼(P<0.05)。

结论

不同年龄组的 ICU 患者可能适合不同的镇痛药。对于 60 岁以下的患者,纳布啡的镇痛和镇静效果优于舒芬太尼,且不会引起呼吸抑制和明显的血流动力学变化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/40d7/8961885/e87bdcb12891/12873_2022_592_Fig1_HTML.jpg

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