芬太尼在机械通气新生儿中的临床评价

Clinical evaluation of fentanyl used in neonates' mechanical ventilation

目的:比较芬太尼和咪唑安定在新生儿机械通气中的镇静效能以及不良反应, 为新生儿机械通气选择理想的镇静剂提供理论依据。方法: 将40例需机械通气的新生儿随机分为芬太尼组(n=20) 和咪唑安定组(n=20), (1) 比较两组用药后30min、6h和12h机械通气参数(RR、PIP、FiO2、PEEP) 和患儿平均血压、心率; (2) 通过新生儿面部编码系统(NF CS) 评价两组患儿用药后30min、6h和12h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 ) 芬太尼组PIP、FiO2、PEEP在用药前和用药后各时段与咪唑安定组相比差异无显著意义(P>0 .05), 而用药后12hRR则低于咪唑安定组(37 .00±3 .77) 次/minVS(40. 00±5 .13) 次/min, P<0. 05; 咪唑安定组用药30min后出现血压下降, 6h后出现心率下降, 与用药前相比差异具有显著性(P<0 .05); 而芬太尼用药后各时段的HR和MBP与用药前相比无显著差异(P>0 .05);(2) 两组在用药后30min, 疼痛行为反应评分明显低于用药前组(P<0 .05), 但各时段两组间比较无显著差异(P>0 .05 );(3) 芬太尼组机械通气时间少于咪唑安定组(25. 35±12. 50) hVS(34 .90±17. 78)h, P<0 .05。结论: 与咪唑安定相比, 芬太尼能降低机械通气的通气频率、缩短机械通气时间, 且心血管的不良反应少。

Objective:To compare the effect and side effect of fentanyl and midazolam in neonates' mechanical ventilation to supply theory basis for selection of better sedative.Methods:40 ventilated neonates were randomly and averagely divided into fentanyl and midazolam group. ①The ventilatory parameters (RR, PIP, FiO 2 and PEEP) at 30 min, 6 and 12 h and average blood pressure and heart rate and the ventilation duration were compared, the pain behavior reaction scores at 30 min, 6 and 12 h of two groups were compared with Neonatal Facial Coding System. Results:①There were no significant difference in PIP, FiO 2 and PEEP before and after treatment between two groups at different periods ( P >0.05); RR at 12 h after treatment in fentanyl group 〔(37.00±3.77)/min〕 was lower than that in midazolam group〔 (40.00±5.13)/min〕( P <0.05); blood pressure decreased at 30 min and heart rate reduced at 6 h after treatment in midazolam group with significant difference comparing to those before treatment ( P <0.05); but there was no significant difference in HR and MBP before and after treatment in fentanyl group ( P >0.05); ②Pain behavior reaction scores in both groups at 30 min after treatment significantly decreased ( P <0.05), but without significant difference at different periods ( P >0.05); ③The ventilation duration in fentanyl group 〔(25.35±12.50)h〕 were lower than that in midazolam group 〔(34.90±17.78)h〕 ( P <0.05).Conclusion:Fentanyl could reduce ventilation frequency, shorten duration and with less side effects on cardiovascular system comparing to midazolam.