芬太尼对机械通气早产儿的镇痛作用  

Effects of analgesia of fentanyl on the preterm infants during mechanical ventilation

作　　者：陈春[1] 时亚平[1] 周微[2] 林锦 林振浪[1] 

机构地区：[1]温州医学院附属育英儿童医院新生儿科,浙江温州325027 [2]辽宁医学院附属第一医院新生儿科,锦州121000 [3]美国西奈山医学中心新生儿科,纽约10029

出　　处：《中国临床药理学杂志》2010年第6期413-416,共4页The Chinese Journal of Clinical Pharmacology

基　　金：浙江省钱江人才培养基金资助项目(2009R10054);温州市科技局对外科技合作交流基金资助项目(2008055)

摘　　要：目的研究芬太尼(强效麻醉性镇痛药)对机械通气呼吸窘迫综合征新生儿的镇痛作用及安全性。方法治疗组(n=30)予芬太尼,对照组(n=30)予安慰剂。用新生儿疼痛评分量表进行疼痛评分,并测定血清皮质醇,记录呼吸机参数、带机时间、达足量肠道喂养时间、住院时间及神经系统不良反应。结果静滴芬太尼后,患儿N-PASS评分、心率及血清皮质醇均明显降低,吸气峰压增高,达到足量肠道喂养的时间延长;而住院时间、带机时间及神经系统不良反应发生率与对照组没有显著差异。结论芬太尼对机械通气新生儿有较好的镇痛和抗应激作用;但会增高呼吸机参数,延长足量肠道喂养时间。Objective To examine the analgesic effect and the safety of fentanyl on preterm infant who was on mechanical ventilation for neonatal respiratory distress syndrome （ NRDS ） . Methods Premature infants were randomly assigned into two groups. The trial group （ n = 30 ） received fentanyl. The control group （n = 30 ） received a volume - matched placebo infusion. The Neonatal Pain, Agitation and Sedation Scale （N- PASS） was used to assess the infants＇ behavior, and serum cortisol level was measured. Ventilator parameters （peak inspiratory pressure and rate, FiO2 ）, duration of mechanical ventilation, days to reach full enteral feeding, length of stay in hospital, and incidence of grade 3 or 4 intraventricular hemorrhage （IVH） were recorded. Results The N - PASS scores and serum cortisol level of the fentanyl treated infants were lower than that of the placebo control group. Peak inspiratory pressure （PIP） in the trial group was higher than that of the control group. Days to reach full enteral nificantly prolonged. There were feeding in the trial group were also signo significant differences in the duration of mechanical ventilation, length of stay in hospital, and the incidence of severe IVH in two groups. Conclusion Fentanyl can significantly reduce the physical stress and N - PASS scores in preterm infants during mechanical ventilation for NRDS. However, fentanyl treatment leads to higher ventilator settings and longer time to reach full enteral feeding.

关 键 词：芬太尼 机械通气 新生儿 镇痛 

分 类 号：R722.6[医药卫生—儿科] R971.1[医药卫生—临床医学]