咪达唑仑联合舒芬太尼治疗重症医学科小儿多发伤24例

24 cases of midazolam combined with sufentanil used for children with multiple injury in intensive care unit

目的观察咪达唑仑联合舒芬太尼在重症医学科中治疗小儿多发伤的镇静、镇痛作用。方法24例重症患儿均给予静脉注射负荷量咪达唑仑0．15～0．30mg／kg，再给予咪达唑仑0．05～0．10mg／（kg·h）、舒芬太尼0．3～1．5μg／（kg·h）微泵注射维持。根据患儿情况个体化调整入量，维持Ramsay镇静评分3～4分。通过监测患者心率、呼吸、平均动脉压、动脉血气进行治疗前后对比评估；对治愈患儿出院后1，2，4周的头痛、嗜睡、共济失调的不良反应进行随访观察。结果在负荷剂量及维持量下所有患儿均能达到镇痛、镇静的效果，Ramsay评分在3～4分。患儿用药5，30，60min后心率、呼吸、平均动脉压、动脉血气均较用药前明显改善（P〈0．01）；4周内不良反应基本消失。结论咪达唑仑联合舒芬太尼持续泵注能显著提高多发伤重症患儿的镇痛、镇静效果。

Objective To study on the sedative and analgesic effects of midazolam combined with sufentanil used for children with multiple injury in intensive care unit（ICU）. Methods The patients was anesthesia induced with iv injection of midazolam 0. 15 -0. 3 mg/kg, then micro injection pump maintenance treatment with midazolam 0.05 - 0.1 rag/（ kg . h）, sufentanil 0.3 - 1.5 μg/（ kg . h）. According to the conditions of patients individual adjustment amount,ramsay scale score of 3 to 4 level. By monitoring the heart rate,respiration frequency,mean arterial pressure and arterial blood gas analysis to evaluate. Cases were cured after 1,2,4 weeks to be observed with headache,drowsiness,ataxia. Results In the loading dose and maintain of all patients were able to achieve the goal of effect, ramsay score were 3 -4. There was significant difference before and after treatment （5,30,60 minutes） in patients （P〈0.01）. Adverse reactions disappeared within 4 weeks. Conclusions Using continuous intravenous infusion midazolam combined with sufentanil in children with multiple injuries can significantly improve the effect of analogue and sedation scale.