咪达唑仑在新生儿机械通气中的临床应用

Clinical effect of midazolam in neonates' mechanical ventilation

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 effect of phenobarbital and midazolam in neonates＇ mechanical ventilation.Methods Retrospective analysis was performed on 273 infants having mechanical ventilation as an adjunctive treatment,had difficulties in lowering the ventilation settings or unstable oxygen saturation due to either seizure or patient-ventilator dysynchrony,and further required sedative treatment.These neonates were divided into the treatment group（midazolam group n=127）and the control group（Phenobarbital group n=126）.Various ventilation settings（PIP,PEEP and FiO2）,average blood pressure,heart rate,blood-gas analysis at 30 min,6 h,12 h,24 h and 48 h after medication;ventilation duration;the pain behavior reaction scores at 30 min,6 h,12 h,24 h,48 h by neonatal facial coding system were compared between two groups.Results（1）Ventilation settings（PIP,PEEP and FiO2）were able to be tilted down more rapidly in midazolam group（P〈0.05）.（2）Pain behavior reaction in both groups at 30 min after treatment significantly decreased（P〈0.05）.There were significant difference at different treatment periods（P〈0.05）.（3）There were no significant difference in ventilation duration between two groups.Conclusion Compared to phenobarbital,midazolam could facilitate in lowering ventilation setting（PIP,PEEP and FiO2）,increase patient-ventilator synchronization,improve mechanical ventilation efficiency.