知识与财富的链接
摘要 目的：探讨艾司氯胺酮对重症机械通气患者镇痛效果、动脉血气指标及炎性因子的影响。方法：选择我院2022年12月至2024年6月期间收治的66例重症机械通气患者进行前瞻性研究,按照信封抽签法分为对照组和研究组,每组各33例。对照组接受瑞芬太尼镇痛治疗,研究组在对照组基础上接受艾司氯胺酮镇痛治疗。对比两组重症监护疼痛观察工具（critical-care pain observation tool, CPOT）评分、血气指标[动脉血氧分压（partial pressure of oxygen, PaO2）和动脉血二氧化碳分压（partial pressure of carbon dioxide, PaCO2）]、脱机成功率、机械通气时间、达到镇痛目标最大瑞芬太尼用量、炎性因子水平[白细胞介素（interleukin, IL）-6、白细胞介素（interleukin, IL）-10、白细胞计数（white blood cell count, WBC）、降钙素原（procalcitonin, PCT）]和不良反应发生率。结果：两组治疗后PaCO2、CPOT评分下降,PaO2升高（P<0.05）。治疗后研究组CPOT评分低于对照组（P<0.05）。研究组的脱机成功率高于对照组,机械通气时间短于对照组,达到镇痛目标最大瑞芬太尼用量低于对照组（P<0.05）。治疗后研究组IL-6、WBC、PCT水平低于对照组,IL-10高于对照组（P<0.05）。两组不良反应发生率组间对比未见差异（P>0.05）。结论：艾司氯胺酮治疗重症机械通气患者,可有效镇痛,提高脱机成功率,缩短机械通气时间,降低炎性因子水平。
ABSTRACT Objective: To investigate the effect of esketamine on the analgesic efficacy, arterial blood gas indicators and inflammatory factors of patients with severe mechanical ventilation. Methods: A prospective study was conducted on 66 patients with severe mechanical ventilation who were admitted to our hospital from December 2022 to June 2024, and they were divided into control group and study group according to the envelope lottery method, with 33 cases in each group. The control group received remifentanil analgesic treatment, and the study group received esketamine analgesic treatment on the basis of the control group. Critical-care pain observation tool (CPOT) score, blood gas indicators [Partial pressure of arterial oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2)], offline success rate, mechanical ventilation time, maximum remifentanil dosage to achieve analgesic goals, inflammatory factors levels [Interleukin (IL)-6, interleukin (IL)-10, white blood cell count (WBC), procalcitonin (PCT)] and the incidence of adverse reactions were compared between the two groups. Results: PaCO2 and CPOT scores decreased, while PaO2 increased after treatment of both groups (P<0.05). The CPOT scores of the study group was lower than that of the control group after treatment (P<0.05). The offline success rate of the study group was higher than that of the control group, the mechanical ventilation time was shorter than that of the control group, and the maximum remifentanil dosage to achieve analgesic goals was lower than that of the control group (P<0.05). IL-6, WBC and PCT levels of the study group after treatment were lower than those of the control group, while IL-10 was higher than that of 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: Esketamine in the treatment of patients with severe mechanical ventilation, can effective analgesia, increase offline success rate, shorten mechanical ventilation time, reduce inflammatory factors levels.
