肌松药在PICU诱导快速顺序气管插管中的应用  

Application of Muscle Relaxant during Induced Rapid Sequential Endotracheal Intubation in PICU

作　　者：蒋丰智[1] 刘伟东[1] 邓皓辉[1] Jiang Fengzhi Liu Weidong Deng Haohui(Dongguan Maternal and Child Healthcare Hospital, Guangdong Dongguan 523000, Chin)

机构地区：[1]广东省东莞市妇幼保健院,广东东莞523000

出　　处：《儿科药学杂志》2017年第7期29-31,共3页Journal of Pediatric Pharmacy

摘　　要：目的:观察肌松药用于儿童重症监护室(PICU)行快速顺序诱导气管插管(RSI)中的临床效果。方法:选取127例PICU使用呼吸机前进行RSI的患儿,按是否加用肌松药随机分为常规组、肌松药组,常规组先后静脉推注咪达唑仑和芬太尼后行RSI,肌松药组在常规组基础上加用维库溴铵后行RSI,观察并记录两组一般情况、Goldberg评分、插管前后心率变化、一次插管成功率、气道黏膜损伤情况、严重心动过缓(<60次/分)进行胸外按压发生率、发生胸廓强直情况及使用呼吸机时间、PICU停留时间和病死率。结果:两组患儿Goldberg评分、插管前后心率变化、一次插管成功率、气道黏膜损伤情况及使用呼吸机时间、PICU停留时间比较差异有统计学意义(P<0.01);严重心动过缓发生率、胸廓强直发生率和病死率比较差异无统计学意义(P>0.05)。结论:肌松药应用于PICU中行RSI的患儿有助于使插管顺利进行,能减轻患儿的痛苦、促进患儿康复,值得临床推广。Objective： To observe the clinical effect of muscle relaxant for rapid sequetial induction tracheal intubation （RSI） in pediatric intensive care unit （PICU）. Methods： One hundred and twenty-seven cases of children with RSI before using ventilator were divided into two groups randomly, conventional group and muscle relaxant group. Conventional group was sequential injected with intravenous injection of midazolam and fentanyl before RSI, muscle relaxant group was sequentially injected with intravenous injection of fentanyl, midaxolamand and vecuronium before RS/. Genera/situation, Goldberg score, heart rate before and after intubation, one-time success rate of intubation, airway mucosa injury, incidence of severe bradycardia （〈 60 times/min ） needing chest compressions, occurrence of thoracic stiffness, mechanical ventilation time, PICU stay time and mortality were observed and recorde＆ Results： Goldberg score, heart rate before and after intubation, one-time success rate of intubation, airway mucosal injury, the mechanical ventilator time and PICU stay time showed significant differences between two groups （P〈0. 01 ）. The incidence of severe bradycardia, thoracic stiffness and mortality showed no significant differences （P〉0. 05）. Conclusion： The application of muscle relaxant in children with RSI in PICU can help to the success of intubation, alleviate the pain and promote the rehabilitation of children, and it is worthy of clinical application.

关 键 词：快速顺序气管插管 肌松药 儿童 重症 

分 类 号：R726.1[医药卫生—儿科]