咪达唑仑消除新生儿机械通气中人-机对抗的疗效观察

Curative effect observation on midazolam in eliminating h-man-machine against of neonatal mechanical ventila- tion

目的探讨咪达唑仑对消除在新生儿机械通气中出现的人一机对抗的临床价值。方法回顾性总结2006年7月至2012年6月在我院新生儿科收住的需要机械通气的出现人一机对抗新生儿病例，并依据是否使用咪达唑仑随机将患儿分为2组：对照组43例给予常规安定、苯巴比妥类和水合氯醛等镇静处理；观察组40例使用咪达唑仑镇静。总结对比两组患儿：（1）呼吸机参数；（2）脱管率；（3）应用机械通气时间；（4）镇静评分，并进行分析。结果观察组用咪达唑仑后吸气峰压由（25．2±0．6）cmH，0下调至（19．2±0．7）cmH20，与对照组（24．7±0．5）emH20下调至（21．3±0．9）cmH20对比，下调明显，差异有统计学意义（P〈0．05）。氧浓度由（65．5±0．5）％下调至（40．6±0．7）％，与对照组由（66．4±0．4）％下调至（62．4±0．6）％对比，下调明显，差异有统计学意义（P〈0．05）。观察组无一例因患儿烦躁导致脱管，对照组有11例，差异有统计学意义（P〈0．05）。观察组应用机械通气时间（79．3±15．5）h明显少于对照组（101．3±16．3）h，差异有统计学意义（1=2．9，P〈0．01）。用药前观察组与对照组的镇静评分差异无统计学意义（P〉0．05），观察组应用咪达唑仑后0．5、1、2、24h无操作时与对照组应用安定、苯巴比妥及／和水合氯醛等维持镇静的评分差异均有统计学意义（P〈0．05）。结论持续静脉滴注咪达唑仑能有效减轻机械通气治疗过程中的不适感，减少生理应激反应，达到自主呼吸与呼吸机协调同步，改善通气，稳定血氧饱和度。

Objective To discuss the clinical value of midazolam in eliminating the man-machine a- gainst of newborn mechanical ventilation. Methods We retrospectively summarized the neonatal cases from July 2006 to June 2012 in our neonatology department with need of mechanical ventilation but having man-machine against, on the basis of whether to use midazolam we randomly divided them into two groups： 43 cases in control group with conventional stability, phenobarbital class and chloral hydrate and calm processing; 40 cases of the observation group used midazolam. Two groups were compared with each other as follows： （~）breathing machine parameters; （~）rate of taking off the tube;（~）the application of mechanical ventilation time; （~）calm score. Then we carried on the analysis. Results The observation group with midazolam after suction peak voltage from （25.2 ＋ 0.6） cm H^O down to （19.2 ＋ 0.7） cm H20, compared with （24.7 _＋ 0.5） cm H20 down to （21.3 ＋ 0.9） cm H20 in the control group, difference had statistical significance （P〈0.05）. Oxygen concentration was （65.5 ＋- 0.5）% down to （40.6 -＋ 0.7）%, and the control group was （66.4 _＋ 0.4）% down to （62.4 _＋ 0.6）% as contrast, cut obvious, differ- ence had statistical significance （P〈0.05）. There was no case of taking off the tube because of being agitated in the observation group, but the control group had 11 cases （/9〈0.05）. Application of mechanical ventilation time of the observation group was （79.3 ＋ 15.5） hours, less than that of control group of （101.3 ＋ 16.3） hours, the differ- ence was statistically significant （l=2.9, P〈0.01）. Before using this drug observation group and control group calm score difference was not statistically significant （P〉O.05）, application midazolam after 0.5, 1, 2 and 24 hours in the observation group with no operation were compared to those of control application stability, phenobarbital and/or chloral hydrate and maintaining calm score differences showed statistically significance （P〈O.05）. Conclu- sion Continuous intravenous drip midazolam can effectively reduce the mechanical ventilation in the course of treatment and discomfort, reduce the physiological stress response to spontaneous breathing and breathing machine coordinate synchronons, improve ventilation, and stable blood oxygen saturation.