【摘要】 目的研究纳布啡对ICU非机械通气患者的镇痛效果及安全性。方法非机械通气、疼痛数字（NRS）评分>4分的患者60例,随机分为纳布啡组和吗啡组,每组30例。观察2组患者给药后1、6、12、24、36、48 h的生命体征[心率（HR）、呼吸（RR）、动脉血压（MAP）、血氧饱和度（SPO₂）]、疼痛评分（VAS评分）、谵妄评估[先采用Richmond躁动镇静量表（RASS评分）对患者意识进行评估,然后行ICU谵妄评估工具（CAM-ICU）评估谵妄发生情况],观察2组不良反应发生情况。结果 2组组间不同时间HR、MAP水平比较,差异均无统计学意义（P>0.05）。纳布啡组除外用药后48 h RR水平低于1 h（P<0.05）,其他不同时间比较,差异均无统计学意义（P>0.05）。吗啡组用药后24、36、48 h RR水平均低于1、6、12 h,且低于同时间纳布啡组水平,差异均有统计学意义（P<0.05）。纳布啡组除外36 h SPO₂水平高于12 h,差异有统计学意义（P<0.05）,其余不同时间均保持平稳（P>0.05）,纳布啡组用药后6、12、24、36 h SPO₂水平均高于吗啡组,差异有统计学意义（P<0.05）。2组用药后24 h、36 h、48 h VAS评分均低于1 h、6 h, 24 h、36 h、48 h,呈逐渐降低趋势,且吗啡组12 h VAS评分低于1 h,纳布啡组24 h VAS评分低于12 h,差异均有统计学意义（P<0.05）。2组不同时间VAS评分组间比较,差异无统计学意义（P>0.05）。吗啡组用药36 h、48 h RASS评分显著低于用药后1 h、6 h、12 h,差异均有统计学意义（P<0.05）。纳布啡组用药后24 h、36 h、48 h RASS评分低于用药后1 h、6 h,差异有统计学意义（P<0.05）。纳布啡组患者1～48 h RASS评分均低于吗啡组,差异均有统计学意义（P<0.05）。纳布啡组患者谵妄发生率为低于吗啡组,差异有统计学意义（P<0.05）。纳布啡组不良反应总发生率显著低于吗啡组,差异有统计学意义（P<0.05）。结论纳布啡用于ICU非机械通气患者的镇痛具有与吗啡相同的镇痛效果,且对患者循环功能影响小,减少呼吸抑制,使患者保持镇定减少谵妄的发生,不良反应发生率低。更多还原

【Abstract】 Objective To investigate the analgesic effects and safety of nalbuphine for the patients treated by nonmechanical ventilation in ICU.Methods A total of 60 patients（nonmechanical ventilation and NRS>4） were randomly divided into nalbuphine group（n=30） and morphine group（n=30）.The patients’ vital signs（HR,RR,MAP,SPO₂）,VAS,delirium assessment（the patients consciousness were firstly evaluated by RASS,then the CAM-ICU for the occurrences of the delirium） were observed at 1 h, 6 h, 12 h, 24 h, 36 h, 48 h after medication, at the same time, the adverse reactions were observed and compared between the two groups.Results There were no significant differences in HR and MAP between the two groups（P>0.05）.In nalbuphine group, the RR levels had no significant differences in different time points（P>0.05）except the RR levels at 48 h was lower than those at 1 h（P<0.05）.In morphine group, the RR levels at 24 h.36 h.48 h were significantly lower than those at 1 h, 6 h, 12 h, and those in nalbuphine group（P<0.05）.Moreover the SPO₂ levels at 36 h in nalbuphine group were significantly higher than those at 12 h（P<0.05）,and the SPO₂ levels at 6 h, 12 h, 24 h, 36 h in nalbuphine group were significantly higher than those in morphine group（P<0.05）.There were no significant differences in VAS scores in different time points between the two groups（P>0.05）. However the RASS scores at 36 h, 48 h in morphine group were significantly lower than those at 1 h, 6 h, 12 h（P<0.05）,moreover, which at 24 h, 36 h, 48 h in nalbuphine group were significantly lower those in morphine group（P<0.05）. In addition the incidence rate of delirium and total incidennce rate of adverse reaction in nalbuphine group were significantly lower than those in morphine group（P<0.05）.Conclusion The nalbuphine has the same analgesic effects as morphine for the patients treated by nonmechanical ventilation in ICU,moreover, the former has little effect on the circulatory function, which can decrease the respiratory depression, keep the patients calm so as to decrease the incidence of delirium and the other adverse reactions.更多还原