咪达唑仑联合芬太尼对危重症肠道病毒71型感染患儿血浆儿茶酚胺的影响  

Effects of Midazolam and Fentanyl Treatment on Plasma Catecholamine Levels in Critically Ill Children with EV71 Infection

作　　者：吴伟[1] 周永柏[1] 王自财[1] 张晓莉[1] 龙娟[1] 伍全概[1] 周曙明[1] 

机构地区：[1]深圳市龙岗中心医院,广东深圳518116

出　　处：《儿科药学杂志》2015年第11期5-7,共3页Journal of Pediatric Pharmacy

基　　金：深圳市科技项目;项目编号201203314;龙岗区科技项目资助;项目编号ys2012177

摘　　要：目的：观察咪达唑仑联合芬太尼对危重症肠道病毒71型（EV71）感染患儿血浆儿茶酚胺水平的影响。方法：选取2012年5月至2014年5月我院PICU收治的危重症EV71感染患儿10例作为观察组,另选同期在我院PICU住院治疗的急性呼吸衰竭患儿10例作为对照组。两组均予咪达唑仑[负荷量0.1 mg/kg,维持量1.0~5.0μg/（kg·min）]和芬太尼[0.5~2.0μg/（kg·h）]镇静治疗。分别于用药前和用药后12 h采集患儿血液标本,采用酶联免疫吸附法（ELISA）测定血浆多巴胺（DA）、肾上腺素（E）、去甲肾上腺素（NE）水平,并比较观察组用药前后的血浆儿茶酚胺（CA）水平。结果：观察组用药前DA（8.84±1.53）ng/m L、E（1.29±0.35）ng/m L、NE（10.19±2.48）ng/m L,用药后DA（8.54±0.52）ng/m L、E（1.15±0.10）ng/m L、NE（8.48±0.44）ng/m L;对照组用药前DA（1.43±0.34）ng/m L、E（0.59±0.15）ng/m L、NE（5.35±1.98）ng/m L。观察组用药前血浆CA（DA、E、NE）水平均高于对照组（P均〈0.01）,用药后血浆DA、E水平与用药前比较差异无统计学意义（P〉0.05）,而血浆NE水平较用药前降低（P〈0.05）。结论：危重症EV71感染患儿血浆CA水平有明显升高,有助于早期发现危重症病例;咪达唑仑联合芬太尼可降低危重症EV71感染患儿血浆NE水平,而对DA、E影响不大。Objective： To investigate the influence of midazolam and fentanyl treatment on plasma catecholamine levels in critically ill children with EV71 infection. Methods： Ten cases of critically ill children with EV71 infection were collected as treatment group from May 2012 to May 2014 in our hospital. Ten children with acute respiratory failure were selected as control group at the same time who were treated in PICU of our hospital. The loading dose 0. 1 mg / kg and maintenance dose 1. 0 ~ 5. 0 μg /（ kg·min） of midazolam were given to the children in treatment group and control group,also fentanyl dose 0. 5 ~ 2. 0 μg /（ kg·h）. The blood samples were taken before and after the treatment of midazolam and fentanyl in treatment and control groups. The plasma dopamine（ DA）,epinephrine（ E）and norepinephrine（ NE） levels were measured by enzyme linked immmunosorbent assay. The plasma CA levels were compared before and after midazolam and fentanyl treatment. Results： Compared with the control group,the plasma catecholamine（ CA） levels were significantly increased in the treatment group（ P〈0. 01）,the plasma levels of DA,E had no significance before and after midazolam and fentanyl treatment（ P〉0. 05）. The plasma NE level after midazolam and fentanyl treatment was lower than before（ P〈0. 05）.Conclusion： The levels of plasma CA significantly increase in critically ill children with EV71 infection. It is helpful to recognize critically ill children with EV71 infection. Midazolam and fentanyl treatment can reduce the plasma NE level in critically ill children with EV71 infection,and have no effect on plasma levels of DA and E.

关 键 词：咪达唑仑 芬太尼 肠道病毒71型 儿茶酚胺 酶联免疫吸附试验 

分 类 号：R720[医药卫生—儿科]