咪达唑仑在早产儿机械通气中的应用研究

Study on Midazolam Used in Mechanical Ventilation of Preterm Infants

[目的]观察咪达唑仑在早产儿机械通气中的应用,评价其临床疗效及可能出现的不良反应.[方法]将本院新生儿重症监护病房（NICU）需要进行呼吸机辅助呼吸的107例早产儿随机分为治疗组和对照组.治疗组在机械通气的同时给予咪达唑仑镇静,对照组当患儿出现人机对抗时临时给予鲁米那或水合氯醛镇静.分别观察两组患儿的镇静情况（早产儿疼痛量表,PIPP评分）、血压、呼吸频率、心率的变化,机械通气持续时间,动脉血气分析,停药后的拔管情况,病死率,气胸发生率,颅内出血发生率,新生儿神经系统评分以及听力通过率.[结果]治疗组所有患儿在静脉持续给予咪达唑仑时能保持良好的安静状态,且有效率100%;病死率、气胸发生率,颅内出血发生率均低于对照组（P〈0.05）;呼吸频率,心率,血氧饱和度在用药后均有所改善;血气分析在用药过程中基本正常,镇静状态下动脉氧分压有所上升;治疗组机械通气时间明显短于对照组（P〈0.05）;符合拔管条件的患儿停药24 h后都能很快拔除气管导管,未见重复上机现象;纠正胎龄40周,体重达到2.5 kg进行新生儿神经系统评分分值和听力通过率与对照组比较无差异.[结论]使用静脉微量泵推注咪达唑仑能很好地应用于NICU中早产儿需要进行有创机械通气的患儿,其镇静效果佳、对循环影响小、能保持患儿的自主呼吸与机械通气协调,减少人机对抗,有效减少病死率,气胸发生率,用药后未见拔管延迟,神经系统损伤。

[Objective] To observe the application of midazolam in mechanical ventilation of preterm infants,and evaluate its clinical effect and possible side effects. [Methods] Totally 107 preterm infants who hosp,tallzed and received mechanical ventilation in the neonatal intensive care unit（NICU） of Xiangya Hospital were randomly divided into treatment group and control group. The treatment group was given midazolam for sedation during mechanical ventilation, and the control group was given luminal or chloral hydrate temporarily when man-machine confrontation happened. Sedation（pain scale of preterm infants, PIPP score）, blood pressure, respiratory rate, heart rate, duration of mechanical ventilation, arterial blood gas analysis, extubation after withdrawal, mortality, incidence of pneumothorax and intracranial hemorrhage, NBNA and pass rate of hearing were observed in both groups. [Results] When midazolam was persistently intravenously given, all pediatric patients in treatment group stayed good resting state, and the effective rate was 100%. The mortality and the incidence of pneumothorax and intracranial hemorrhage in treatment group were significantly lower than those in control group（ P 〈0.05）. The respiratory rate, heart rate and SPO2 improved after medication. Arterial blood gas analysis was normal and PO2 increased in resting state. The duration of mechanical ventilation in treatment group was significantly shorter than that in control group（ P 〈0.05）. Pediatric patients who fit the conditions of extubation were extubated 24h after withdrawal, and mechanical ventilation was not performed again. There was no significance in NBNA and pass rate of hearing between treatment and control group when the corrected gestational age reached 40 weeks and the weight came to 2.5kg. [Conclusion]Micro-pumping midazolam by intravenous micropump can be well applied in the preterm infants of NICU who need invasive mechanical ventilation. Midazolam has good sedative effect and little impact on the circulation, and can maintain spontaneous respiration coordinating with mechanical ventilation, reduce man-machine confrontation, and decrease the mortality and the incidence of pneumothorax. After medication, side effects such as extubation delay, nervous system damage and hearing damage are not found.