舒芬太尼与芬太尼对重症患者机械通气血流动力学的影响
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摘要
目的研究舒芬太尼(sufentanil)与芬太尼(fentanil)对重症患者机械通气血流动力学的影响。方法计算机检索PubMed、The Cochrane Library、CNKI、VIP及WanFang Data数据库,查找比较舒芬太尼与芬太尼对重症患者机械通气血流动力学影响的随机对照试验(RCT),检索时限为建库至2018年4月25日。同时手检纳入文献的参考文献。按纳入与排除标准由两人独立进行文献的筛选、资料提取和质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入11个研究,舒芬太尼组307例,芬太尼组302例。Meta分析结果显示:舒芬太尼组较对照组插管后收缩压低[MD=-10.51,95%CI (-20.50,-0.53), P=0.04];舒芬太尼组平均动脉压较对照组高[MD=7.86, 95%CI(5.37,10.34),P<0.01];舒芬太尼组插管后心率较对照组低[MD=-7.63, 95%CI (-14.25,-1.01),P=0.02];舒芬太尼组插管后心指数较对照组高[MD=7.76,95%CI (6.45, 9.06),P<0.01];舒芬太尼组插管各期的舒张压、呼吸频率及氧饱和度与对照组相比,差异均无统计学意义(P>0.05)。结论舒芬太尼组较芬太尼组对插管后危重患者的循环系统抑制更低,血流动力学更稳定,更好地保护机械通气患者的心肺功能。
Objective To systematically evaluate effect of sufentanil versus fentanil on hemodynamics in critical patients with mechanical ventilation(MV). Methods The randomized controlled trials(RCTs) about sufentanil vs the date of their establishment. Fentanil for critical patients with MV was searched in PubMed, The Cochrane Library,CNKI, VIP and Wanfang Database from inception to April 25 th, 2018 and other relevant journals and references of the included literature were also searched manually. Two reviewers independently screened the studies according to the inclusion and exclusion criteria. Then, meta-analysis was performed using RevMan 5.3 software. The level of evidence was assessed by using Cochrane handbook. Results A total of eleven RCTs were included, of which there were 307 patients in sufentanil group while 302 patients in fentanil group. The results of meta-analysis showed that sufentanil group had lower systolic blood pressure(SBP) than fentanil group after MV(MD=-10.51, 95%CI-20.50 to-0.53, P=0.04), higher mean blood pressure(MBP) than Fentanil after MV(MD= 7.86, 95% CI 5.37 to 10.34, P<0.001), lower heart rate(HR)(MD=-7.63, 95%CI-14.25 to-1.01, P=0.02), Sufentanil groups had higher cardiac index(CI)(MD=7.76, 95%CI 6.45 to 9.06, P<0.01). There were no significant difference in diastolic blood pressure(DBP), respiratory rate(RR), SpO_2 between the two groups during and after MV. Conclusion Current evidence shows that sufentail has less restraining impact on cardiovascular system, with more stable hemodynamics, which can better protect the cardio-pulmonary function.
Objective To systematically evaluate effect of sufentanil versus fentanil on hemodynamics in critical patients with mechanical ventilation(MV). Methods The randomized controlled trials(RCTs) about sufentanil vs the date of their establishment. Fentanil for critical patients with MV was searched in PubMed, The Cochrane Library,CNKI, VIP and Wanfang Database from inception to April 25 th, 2018 and other relevant journals and references of the included literature were also searched manually. Two reviewers independently screened the studies according to the inclusion and exclusion criteria. Then, meta-analysis was performed using RevMan 5.3 software. The level of evidence was assessed by using Cochrane handbook. Results A total of eleven RCTs were included, of which there were 307 patients in sufentanil group while 302 patients in fentanil group. The results of meta-analysis showed that sufentanil group had lower systolic blood pressure(SBP) than fentanil group after MV(MD=-10.51, 95%CI-20.50 to-0.53, P=0.04), higher mean blood pressure(MBP) than Fentanil after MV(MD= 7.86, 95% CI 5.37 to 10.34, P<0.001), lower heart rate(HR)(MD=-7.63, 95%CI-14.25 to-1.01, P=0.02), Sufentanil groups had higher cardiac index(CI)(MD=7.76, 95%CI 6.45 to 9.06, P<0.01). There were no significant difference in diastolic blood pressure(DBP), respiratory rate(RR), SpO_2 between the two groups during and after MV. Conclusion Current evidence shows that sufentail has less restraining impact on cardiovascular system, with more stable hemodynamics, which can better protect the cardio-pulmonary function.
引文
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[18]刘鲲鹏,薛富善,许亚超,等.小剂量芬太尼、瑞芬太尼和舒芬太尼预防儿童经口气管插管心血管反应的比较[J].实用儿科临床杂志,2007, 22(5):391-394.
[19]郭峰,张兴森,徐丽霞,等.舒芬太尼与芬太尼对机械通气患者镇痛的效果比较[J].现代生物医学进展, 2015, 15(23):4548-4550.
[20]谢瑜,贺亮.不同剂量舒芬太尼用于老年患者全麻诱导的临床观察[J].医学临床研究, 2010, 27(8):1475-1477.
[21] MACIEJEWSKI D. Sufentanil in anaesthesiology and intensive therapy[J]. Anaesthesiol Intensive Ther, 2012, 44(1):35-41.
[22] ZHOU Y, WANG Z, QIN LD, et al. Early altered resting-state functional connectivity predicts the severity of post-traumatic stressdisorder symptoms in acutely traumatized subjects[J]. PLoS One, 2012, 7(10):e46833.
[23] CONTI G, ARCANGELI A, ANTONELLI M, et al. Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respriation:a pilot study[J]. Can J Anaesth, 2004, 51(5):494-499.
[24]范明亮.镇静镇痛在机械通气患者治疗中的应用效果观察[J].临床合理用药, 2014, 7(1A):101-102.
[25]熊朝晖,陈运良,秦素兰.不同剂量舒芬太尼对老年患者全麻诱导期血流动力学的影响[J].四川医学,2013, 34(3):363-365.
[26]徐露,李元海.舒芬太尼的药理作用和临床应用研究进展[J].安徽医药, 2011, 15(3):315.
[2] FULLER BM, MOHR NM, DETTMER M, et al. Mechanical ventilation acute lung injury in emergency department patients with sepsis and septic shock:an observational study[J]. Acad Emerg Med, 2013,20(7):659-669.
[3] KANG YA. Risk factors and outcomes associated with readmission to the Intensive Care Unit after cardiac surgery[J]. AACN Adv Crit Care, 2016, 27(1):29-39.
[4]马朋林,刘京涛.“无镇静”:梦想还是梦魇?[J].中华危重急救医学, 2012, 24(5):257-259.
[5] GELINAS C. Management of pain in cardiac surgery ICU patients:have we improved over time?[J]. Intensive Crit Care Nurs, 2007,23(5):298-303.
[6] BARR J, FRASER GL, PUNTILLOK, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1):263-306.
[7] PANDHARIPANDE PP, PATEL MB, BARR J. Management of pain,agitation, and delirium in critically ill patients[J]. Pol Arch Med Wewn, 2014, 124(3):114-123.
[8] JULIAN PT, HIGGIN S, SALLY G. Cochrane Handbook for Systematic Reviews of Interventions[EB/OL]. The Cochrane Collaboration,2013. http://www.community.cochrane.org/handbook.
[9]涂慧慧,夏中元,万杏,等.舒芬太尼对多发伤术后机械通气患者镇静镇痛效果的观察[J].临床外科杂志, 2015, 6(23):464-466.
[10]吴捷,张建凤,封海彬,等.芬太尼、舒芬太尼、瑞芬太尼联合右美托咪定在机械通气患者中应用的比较[J].医学理论与实践, 2013, 26(22):2948-2950.
[11]王伟,杨万杰,冯庆国,等.不同镇静药物对老年机械通气患者血流动力学的影响[J].中华危重病急救医学, 2015, 27(10):853-855.
[12]牛晓娟,刘炜,孙红芳.舒芬太尼对老年患者气管插管时血流动力学的影响[J].临床麻醉学杂志, 2010, 26(7):593-594.
[13]曹天彪,张晓勇.芬太尼、舒芬太尼和瑞芬太尼复合普鲁泊福用于重症监护病房镇静机械通气效果的比较[J].中国医师进修杂志,2010, 33(24):50-52.
[14]陈兴东,史正山,林宁,等.舒芬太尼和芬太尼对患者气管插管时心血管反应的影响[J].临床麻醉学杂志, 2006, 22(8):614-615.
[15]邓琳,李新,余锡斌.舒芬太尼与芬太尼应用于机械通气患者的镇静效果比较[J].实用医院临床杂志, 2014, 11(4):188-190.
[16]丁耀茂,林红,丁伟.舒芬太尼、瑞芬太尼、芬太尼对全麻患者气管插管心血管反应的影响[J].现代医院, 2010, 10(3):28-30.
[17]李星宇.术后机械通气患者镇痛方案研究[J].现代医药卫生, 2016,32(12):1816-1818, 1821.
[18]刘鲲鹏,薛富善,许亚超,等.小剂量芬太尼、瑞芬太尼和舒芬太尼预防儿童经口气管插管心血管反应的比较[J].实用儿科临床杂志,2007, 22(5):391-394.
[19]郭峰,张兴森,徐丽霞,等.舒芬太尼与芬太尼对机械通气患者镇痛的效果比较[J].现代生物医学进展, 2015, 15(23):4548-4550.
[20]谢瑜,贺亮.不同剂量舒芬太尼用于老年患者全麻诱导的临床观察[J].医学临床研究, 2010, 27(8):1475-1477.
[21] MACIEJEWSKI D. Sufentanil in anaesthesiology and intensive therapy[J]. Anaesthesiol Intensive Ther, 2012, 44(1):35-41.
[22] ZHOU Y, WANG Z, QIN LD, et al. Early altered resting-state functional connectivity predicts the severity of post-traumatic stressdisorder symptoms in acutely traumatized subjects[J]. PLoS One, 2012, 7(10):e46833.
[23] CONTI G, ARCANGELI A, ANTONELLI M, et al. Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respriation:a pilot study[J]. Can J Anaesth, 2004, 51(5):494-499.
[24]范明亮.镇静镇痛在机械通气患者治疗中的应用效果观察[J].临床合理用药, 2014, 7(1A):101-102.
[25]熊朝晖,陈运良,秦素兰.不同剂量舒芬太尼对老年患者全麻诱导期血流动力学的影响[J].四川医学,2013, 34(3):363-365.
[26]徐露,李元海.舒芬太尼的药理作用和临床应用研究进展[J].安徽医药, 2011, 15(3):315.