Comparison Of Analgesic Effect Between Remifentanil And Fentanyl In ICU Mechanically Ventilated Patients

Objectives Comparison of analgesic efficacy and safety of remifentanil and fentanil in patients with ICU mechanical ventilation.Provide reliable clinical evidence for the best treatment options for patients.Methods From November 2018 to November 2019,83 patients with mechanical ventilation who met ICU inclusion criteria and did not meet any exclusion criteria were divided into remifentanil group and sub-tany group by random number method,40 cases in remifentanil group and 43 cases in fentanil group.All subjects,after the establishment of the group,immediately analgesic sedation treatment,that is,drug intervention,active treatment,to maintain vital signs,internal environment,electrolyte stability.Assessment of the condition after 24 hours of mechanical ventilation: if the cause of mechanical ventilation is improved or removed,the patient began to withdraw the screening test;the who meet the withdrawal screening test gradually reduced to stop sedative.To perform an autonomous breathing test;if the patient is able to tolerate pontaneous breathing,prepare for extubation and reduce the analgesics until they stop.Pull out tracheal intubation.If the cause of mechanical ventilation does not improve or remove,offline failure to continue treatment,and then according to the above procedures;if still failed and mechanical ventilation time more than 14 days,the observation index is calculated by 14 days.Methods of drug intervention: Remifentanil group was treated with remifentanil μg/kg/min 0.025 and fentanil group with 0.025 μg/kg/min citrate.Both groups were combined with propofol 0.5 mg/kg/h to maintain intravenous infusion sedation and adjust the intervention dose according to the CPOT、RASS score.Main observation indicators: percentage of time to meet the standard.Secondary indicators of observation: mean of analgesics per hour,mean of sedatives;time of mechanical ventilation,time of extubation offline,time of ICU hospitalization,cost of ICU hospitalization,incidence of adverse reactions.A statistical analysis of the results of the observed indicators was carried out using SPSS 22.0 software.Results 1 The comparison between remifentanil and fentanyl groups in terms of sex,age,BMI,MAP,HR,etiology composition,disease severity composition,P>0.05,the difference was not statistically significant,and the two groups were comparable.2 Between the two groups in terms of the percentage of time to meet the standard,P>0.05,the difference was not statistically significant.3 Between the two groups,the mean value of analgesics and sedatives,P<0.05,was statistically significant.4 Between the two groups in the comparison of mechanical ventilation time and offline extubation time,P<0.05,the difference was statistically significant.5 The two groups P>0.05 in the comparison of ICU hospitalization time and cost,the difference was not statistically significant.6 Comparison of the incidence of adverse reactions between remifentanil and fentanyl,P>0.05,the difference was not statistically significant.Conclusions 1 In mechanical ventilation patients,low dose remifentanil and fentanyl combined with propofol can achieve satisfactory analgesia and sedation.2 Compared with fentanyl,the application of low dose remifentanil in patients with mechanical ventilation can reduce the dose of analgesics and sedatives,and shorten the time of mechanical ventilation and extubation offline.Figure 2;Table 6;Reference 153...