咪达唑仑联合芬太尼在新生儿呼吸窘迫综合征机械通气治疗中的应用效果分析

Analysis on the application effect of midazolam combined with fentanyl in mechanical ventilation treatment of neonatal respiratory distress syndrome

目的分析咪达唑仑联合芬太尼在新生儿机械通气中的镇静效果,为机械通气治疗的患儿进行有效的镇静干预提供参考。方法选取2014年9月-2016年3月就诊于南通大学附属医院采用机械通气治疗的新生儿呼吸窘迫综合征患儿87例,根据镇静药物的不同将其分为观察组44例和对照组43例;观察组患儿采用咪达唑仑联合芬太尼治疗,对照组患儿单纯采用咪达唑仑治疗。观察比较两组患儿用药前、用药后(20 min及1、4、12、24、48 h)呼吸机参数和患儿平均血压,心率;采用NPASS评分量表对两组患儿各同时段(20 min及1、4、12、24、48 h)疼痛反应进行评估,比较两组患儿机械通气治疗时间、撤药至撤机时间。结果给药前两组患儿呼吸机参数、平均血压、心率差异无统计学意义(P>0. 05);给药后观察组患儿各时段呼吸机参数、平均血压、心率均低于对照组患儿,差异有统计学意义(P<0. 05)。给药前两组患儿N-PASS评分差异无统计学意义(P>0. 05);给药后观察组患儿在各时段N-PASS评分均低于对照组患儿,差异有统计学意义(P<0. 05)。两组患儿机械通气治疗时间、撤药至撤机时间差异有统计学意义(P<0. 05)。结论咪达唑仑联合芬太尼应用于新生儿呼吸窘迫机械通气治疗安全有效,能减轻患儿疼痛,减少患儿应激反应发生,降低人机对抗的出现。

Objective To analyze the sedative effect of midazolam combined with fentanyl in mechanical ventilation treatment of neo- nates, provide a reference for effective sedation of neonates treated by mechanical ventilation. Methods Eighty-seven neonates with respir- atory distress syndrome treated by mechanical ventilation in Affiliated Hospital of Nantong University from September 2014 to March 2016 were selected and divided into observation group （44 neonates） and control group （43 neonates） according to Sedative drugs. The neonates in observation group were treated by midazolam combined with fentanyl, the neonates in control group were treated by midazolam. Ventilator parameters, mean blood pressures, and heart rates of neonates before treatment and at 20 minutes, 1, 4, 12, 24, and 48 hours after treatment in the two groups were observed and compared. N-PASS rating scale was used to evaluate pain reaction at different time points （20 minutes, 1, 4, 12, 24, and 48 hours after treatment） . The treatment time of mechanical ventilation and the time from drug withdrawal to ventilator weaning in the two groups were compared. Results Before treatment, there was no statistically significant difference in ventilator parameters, mean blood pressure, and heart rate between the two groups （P〉0. 05） . After treatment, ventilator parameters, mean blood pressure and heart rate at different time points in observation group were statistically significantly lower than those in control group （P〈 0. 05 ） . Before treatment, there was no statistically significant difference in N-PASS score between the two groups （P〉0. 05 ） . After treat- ment, N-PASS scores at different time points in observation group were statistically significantly lower than those in control group （P〈 0. 05 ） . There were statistically significant differences in treatment time of mechanical ventilation and the time from drug withdrawal to venti- lator weaning between the two groups （P〈0. 05 ） . Conclusion Midazolam combined with fentanyl is safe and effective in mechanical venti- lation treatment of neonatal respiratory distress syndrome, which can alleviate pain, reduce stress reaction and occurrence of human-ma- chine confrontation.