丙泊酚联合芬太尼在机械通气患儿镇静中的效果观察

Effect of sedation with propofol and fentanyl on children undergoing mechanical ventilation

目的探讨机械通气患儿应用丙泊酚与芬太尼联合镇静的效果和安全性。方法选择本院儿科PICU中需要镇静进行机械通气的患儿56例,随机分为丙泊酚组(P组)28例,丙泊酚和芬太尼联合组(P/F组)28例。两组均在负荷量后用微量泵持续静脉泵入维持量。监测用药初期0min、60min呼吸和循环参数的变化,以后每2h根据Ramsay镇静评分3～4分,人机顺应性评分≥3分,观察镇静评分调整药物输注速度,以达到最佳的镇静程度;镇静结束停药后观察苏醒时间、并发症、记录药物的剂量、镇静满意度和人机顺应性满意度、机械通气时间。结果两组患儿参数基线差异均无统计学意义(P>0.05);两组镇静60min后心率、呼吸频率和气道峰压都明显低于给药前(P<0.05);P组血压比镇静前降低(P<0.05);P/F组镇静满意度和人机顺应性满意度都明显高于P组(P<0.01);P/F组恢复时间短于P组(P<0.05);P/F组总通气时间短于P组,并发症少。结论机械通气患儿应用丙泊酚与芬太尼联合镇静具有较好的镇静效果,减少人机对抗,改善机械通气效果,未发现严重不良反应,达到PICU机械通气患儿所需的镇静要求。

Objective To investigate the effect of sedation with propofol combined with fentanyl on children undergoing mechanical ventilation in pediatric intensive care unit （PICU）. Methods 56 children undergoing mechanical ventilation admitted to the PICU of our hospital were assigned randomly into group P （treated by propofol） and group P/F （treated by propofol combined with fentanyl）. The two groups received a bolus of intravenous （i.v.） loading dose along with infusion maintenance dose. The respiratory and circulatory parameters were recorded at 0 mln and 60 min after the treatment, followed respectively by assessment of sedative degree every two hours. The sedatives were infused continuously to achieve a target Ramsay scale of 3 to 4 and ventilator synehronal score of adaptation to the intensive care environment more than 3. The recovery time, complications, dosage, satisfactory degree on sedation and ventilator synehronal score were recorded. Results There were no significant difference between the two groups in baseline parameters （P〉0.05）. The heart rate, respiratory rate and airway peak pressure 60min after the treatment in the two groups decreased significantly （P〈0.05） compared with that before the treatment, and the mean blood pressure in group P decreased （P〈0.05）. In group P/F, the satisfactory degree on sedation and ventilator synchronal score of adaptation to the intensive care environment were significantly higher than those in group P （P〈0.05）, the recovery time was shorter （P〈0.05）, and the complications were less. Conclusion Combination of propofol and fentanyl showed satisfactory sedative efficacy and safety in children undergoing mechanical ventilation, which could enhance the compliance of ventilated children to ventilator and improve the ventilation effect.