右美托咪定对机械通气患儿镇静效果的临床研究

Clinical study of sedative effect of dexmedetomidine on children with mechanical ventilation

目的探究右美托咪定应用于机械通气患儿的镇静效果及不良反应。方法选取2013-03—2017-03就诊于周口市中心医院PICU,需行机械通气辅助治疗并需镇静的患儿120例,随机分为观察组和对照组,观察组应用右美托咪定镇静,对照组采用咪达唑仑镇静。记录比较2组患儿镇静药物起效时间、停药后唤醒时间、达到镇痛满意和芬太尼的使用剂量。同时比较2组患儿镇静药物不良反应发生率。分析比较2组患儿PICU时间及机械通气时间差异。结果观察组达到镇静满意时间较对照组明显减少(P<0.05);同时停用镇静药物后,观察组唤醒所需时间也较对照组明显下降(P<0.05)。另外观察组达到镇痛满意所需芬太尼的使用剂量较对照组明显减少(P<0.05)。观察组发生心动过缓或低血压,恶心、呕吐,呼吸抑制及谵妄的患儿比例较对照组显著较少(P<0.05)。但2组患儿入住PICU时间及机械通气时间均无明显差异(P>0.05)。结论右美托咪定在小儿机械通气的镇静中,有着良好的镇静效果与较低的不良反应,值得临床推广应用。

Objective To investigate the sedative effect and adverse reactions of dexmedetomidine in children with mechanical ventilation.Methods One hundred and twenty children with pediatric complications were enrolled in PICU at Zhoukou Central Hospital from March 2013 to March 2017.They were randomly divided into observation group and control group.The observation group was treated with dexmedetomidine.The control group was sedated with midazolam.The sedative drug onset time,withdrawal time after drug withdrawal and satisfaction of analgesia were compared between the two groups,and the dosage of fentanyl used was recorded.At the same time,the incidence of adverse drug reactions to sedation in both groups was analyzed and compared.In addition,the differences in PICU time and mechanical ventilation time between the 2 groups were analyzed.Results Compared with the control group,the satisfaction time of the observation group was significantly reduced（P〈0.05）.After the cessation of sedation,the time needed for awakening in the observation group was also significantly lower than that of the control group（P〈0.05）.In addition,the dosage of fentanyl required for analgesia in the observation group was significantly lower than that in the control group（P〈0.05）.The proportion of children with bradycardia or hypotension,nausea,vomiting,respiratory depression and sputum was significantly lower in the observation group than in the control group（P〈0.05）.However,there was no significant difference in PICU time and mechanical ventilation time between the two groups（P〈0.05）.Conclusion Dexmedetomidine has good sedative effect and low adverse reactions in pediatric mechanical ventilation sedation,which is worthy of clinical application.