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目的比较苯巴比妥和咪达唑仑在新生儿机械通气中的镇静效果。方法回顾性分析临床上存在人机对抗、抽搐以致呼吸机参数下调困难、血氧饱和度不稳定而需用镇静药物治疗的253例机械通气的新生儿,根据使用镇静药物的不同分为治疗组(咪达唑仑组n=127)和对照组(苯巴比妥组n=126);(1)比较两组用药0.5、6、12、24及48h机械通气参数(PIP、PEEP、FiO2)和患儿平均血压、心率及血气分析;(2)通过新生儿面部编码系统评价两组患儿用药后0.5、6、12、24、48h的疼痛行为反应评分;(3)比较两组患儿机械通气时间。结果(1)咪达唑仑组PIP、PEEP、FiO2在用药后迅速下调,与苯巴比妥组比较差异有统计学意义(P<0.05);(2)两组用药30min后,疼痛行为反应评分明显低于用药前(P<0.05),用药后各时段两组间比较差异均有统计学意义(P<0.05);(3)两组机械通气时间差异无统计学意义。结论与苯巴比妥相比,咪达唑仑能降低呼吸机参数(PIP、PEEP、FiO2),改善患儿的人机同步性,提高机械通气的有效性。
Objective To compare the sedation of phenobarbital and midazolam in neonatal mechanical ventilation. Methods Retrospective analysis of 253 cases of mechanically ventilated newborns with clinically confronted with man-machine-confrontation, convulsions, ventilatory parameters down-regulation, unstable blood oxygen saturation and sedation medication were divided into treatment group (N = 127 in midazolam group) and control group (n = 126 in phenobarbital group); (1) The mechanical ventilation parameters of PIP, PEEP and FiO2 were compared between the two groups And the average blood pressure, heart rate and blood gas analysis of children; (2) Evaluation of the pain behavior response scores of the two groups at 0.5, 6, 12, 24, 48 hours after treatment by the newborn facial coding system; (3) Mechanical ventilation time. Results (1) PIP, PEEP and FiO2 in midazolam group were decreased rapidly after treatment with phenobarbital group (P <0.05). (2) After 30 minutes of treatment, the pain behavior response (P <0.05). The differences between the two groups after treatment were statistically significant (P <0.05). (3) There was no significant difference in the time of mechanical ventilation between the two groups. Conclusion Compared with phenobarbital, midazolam can reduce ventilatory parameters (PIP, PEEP, FiO2), improve the synchronicity of children and improve the effectiveness of mechanical ventilation.