瑞芬太尼复合咪达唑仑在新生儿机械通气中安全性和有效性的临床观察  

Clinical observation of safety and efficacy of remifentanil combined with midazolam in neonatal mechanical ventilation

作　　者：张海亮[1] 郝静静[2] 李玲霞[1] 白延斌[1] ZHANG Hailiang;HAO Jingjing;LI Lingxia;BAI Yanbin(Department of Anesthesiology,Affiliated Hospital of Yan’an University,Yan’an,Shaanxi 716000,China;Department of Neonatology,Affiliated Hospital of Yan’an University,Yan’an,Shaanxi 716000,China)

机构地区：[1]延安大学附属医院麻醉科,陕西延安716000 [2]延安大学附属医院新生儿科,陕西延安716000

出　　处：《安徽医药》2020年第10期2071-2074,共4页Anhui Medical and Pharmaceutical Journal

基　　金：陕西省自然科学基础研究计划(2018JM7067);陕西省社会发展科技攻关项目(2016SF-075)。

摘　　要：目的探讨瑞芬太尼复合咪达唑仑在新生儿机械通气中安全性和有效性。方法选择2017年1月至2019年1月在延安大学附属医院新生儿科接受机械通气治疗的病儿90例。按随机数字表法分为研究组(瑞芬太尼复合咪达唑仑)与对照组(5%葡萄糖),每组各45例。研究组病儿在机械通气过程中使用瑞芬太尼复合咪达唑仑镇静;对照组病儿使用5%葡萄糖。记录两组病儿一般情况(性别、胎龄、体质量);观察并记录两组病人用药后30 min、1 h、12 h、24 h、48 h的早产儿疼痛量表(PIPP疼痛评分);监测并记录用药后30 min、1 h、12 h、24 h、48 h两组病儿的平均动脉压、呼吸频率、心率、经皮血氧饱和度、吸入氧浓度;观察并记录带机时间、达到足量肠喂养时间、住院时间。结果研究组与对照组在各时间点经皮血氧饱和度相比较差异无统计学意义(P>0.05);研究组在用药后各时间点平均动脉压[30 min(45.2±6.1)比(47.3±5.1),1 h(43.2±5.3)比(48.2±6.3),12 h(40.1±4.5)比(49.2±5.6),24 h(38.3±5.3)比(48.3±6.2),48 h(36.2±4.2)比(47.3±6.1)]mmHg、心率[30 min(145±14)比(146±15),1 h(140±13)比(149±16),12 h(135±14)比(147±17),24 h(130±12)比(149±15),48 h(141±14)比(148±14)]次/分、呼吸频率[30 min(50.1±5.8)比(56.7±5.3),1 h(46.2±7.8)比(59.3±6.2),12 h(43.4±3.8)比(56.4±5.2),24 h(40.1±4.7)比(58.7±6.8),48 h(37.5±5.6)比(54.3±5.1)]次/分、PIPP疼痛评分[30 min(8.5±4.3)比(14.5±3.7),1 h(7.2±3.4)比(15.1±3.7),12 h(6.5±2.1)比(15.6±2.7),24 h(5.5±2.4)比(15.3±2.3),48 h(3.4±1.5)比(15.0±2.6)]分、吸入氧浓度[30 min(38.3±8.2)比(44.3±8.7),1 h(36.2±9.3)比(45.7±6.9),12 h(33.5±9.8)比(42.5±7.9),24 h(30.2±7.9)比(41.8±6.7),48 h(28.9±8.7)比(40.5±4.2)]%均低于对照组,差异有统计学意义(P<0.05);研究组病人的带机时间[(87.7±18.3)比(96.4±19.4)h]、达到足量肠喂养时间[(6.1±1.4)比(8.9±1.3)d]、住院时间[(33.5±2.7)比(38.7±3.4)d]短于对照组(P<0.05)。�Objective To investigate the safety and efficacy of remifentanil combined with midazolam in neonatal mechanical ventilation.MethodsNinety children who received mechanical ventilation in the Department of Neonatology,Affiliated Hospital of Yan’an University from January 2017 to January 2019 were selected.They were randomly assigned into study group(n=45)and control group(n=45).The children in the study group were treated with remifentanil combined with midazolam during mechanical ventilation,while the children in the control group were treated with 5%glucose.The general conditions(sex,gestational age,body weight)of the two groups were recorded,the prematureinfantpainprofile of the two groups were observed and recorded at 30 min,1 h,12 h,24 h and 48 h after treatment.ResultsThe difference of blood oxygen saturation in the study group and the control group was not statistically significant(P>0.05).The mean arterial pressure[30 min(45.2±6.1)vs.(47.3±5.1),1 h(43.2±5.3)vs.(48.2±6.3),12 h(40.1±4.5)vs.(49.2±5.6),24 h(38.3±5.3)vs.(48.3±6.2),48 h(36.2±4.2)vs.(47.3±6.1)]mmHg,heart rate[30 min(145±14)vs.(146±15),1 h(140±13)vs.(149±16),12 h(135±14)vs.(147±17),24 h(130±12)vs.(149±15),48 h(141±14)vs.(148±14)]bpm,respiratory frequency[30 min(50.1±5.8)vs.(56.7±5.3),1 h(46.2±7.8)vs.(59.3±6.2),12 h(43.4±3.8)vs.(56.4±5.2),24 h(40.1±4.7)vs.(58.7±6.8),48 h(37.5±5.6)vs.(54.3±5.1)]bpm,pipp pain score[30 min(8.5±4.3)vs.(14.5±3.7),1 h(7.2±3.4)vs.(15.1±3.7),12 h(6.5±2.1)vs.(15.6±2.7),24 h(5.5±2.4)vs.(15.3±2.3),48 h(3.4±1.5)vs.(15.0±2.6)]p and inhaled oxygen concentration[30 min(38.3±8.2)vs.(44.3±8.7),1 h(36.2±9.3)vs.(45.7±6.9),12 h(33.5±9.8)vs.(42.5±7.9),24 h(30.2±7.9)vs.(41.8±6.7),48 h(28.9±8.7)vs.(40.5±4.2)]%in the study group were significantly lower than those in the control group at each time point after treatment(P<0.05).The duration of mechanical ventilation was shorter in the study group[(87.7±18.3)vs.(96.4±19.4)]hthan that in the control group.The carrying time of the patients[

关 键 词：呼吸 人工 瑞芬太尼 咪达唑仑 镇静 应激 生理学 婴儿 新生 

分 类 号：R726.1[医药卫生—儿科]