右美托咪定对新生儿机械通气患者血流动力学参数及应激反应的影响

Effect of dexmedetomidine on hemodynamic parameters and stress response in neonates with mechanical ventilation

目的:探讨右美托咪定对新生儿机械通气患儿血流动力学及应激的影响。方法:按照镇静用药方案不同将106例行机械通气治疗的新生儿患儿分为两组,每组各53例。两组患儿均行机械通气治疗,对照组患儿给予咪达唑仑注射液镇静、镇痛,观察组则给予右美托咪定。比较两组镇静镇痛效果、血流动力学参数、应激反应及不良反应发生情况。结果:观察组患者镇静药物起效时间、停药后唤醒时间及芬太尼用量均低于对照组,差异有统计学意义(P<0.05)。药物起效后5 min,两组患者心率及呼吸率均较用药前下降(P<0.05),且观察组的下降幅度更大(P<0.05);药物起效后5 min,两组平均动脉压均低于用药前(P<0.05),两组平均动脉压用药前及药物起效后5 min,比较差异无统计学意义(P>0.05)。药物起效后5 min,两组患者N-PASS疼痛、躁动维度得分均下降(P<0.05),且观察组下降幅度更大(P<0.05)。对照组发生5例(9.43%)不良反应,观察组出现3例(6.98%)不良反应,两组比较差异无统计学意义(P>0.05)。结论:右美托咪定与咪达唑仑相比可有效加快机械通气新生儿患者药物起效时间,缩短停药后唤醒时间,降低芬太尼用量,同时对患儿的血流动力学参数及应激反应影响更小且不增加不良反应发生率。

Objective:To explore the effect of dexmedetomidine on hemodynamics and stress response in neonates with mechanical ventilation.Methods:106 neonatal patients treated with mechanical ventilation were divided into two groups according to different sedative regimens, with 53 cases in each group.The children in both groups were treated with mechanical ventilation.The control group was given midazolam injection for sedation and analgesia, while the observation group was given dexmedetomidine.The sedative and analgesic effects, hemodynamic parameters, stress reactions and adverse reactions were compared between the two groups.Results:The onset time of sedative drugs, the wake-up time after stopping the drug and the dosage of fentanyl in the observation group were lower than those in the control group, and the difference was statistically significant(P<0.05).The heart rate and respiratory rate of the two groups decreased significantly 5 min after the drug took effect(P<0.05),and the decrease in the observation group was more(P<0.05).The mean arterial pressure of the two groups at 5 min after drug onset was lower than that before drug administration(P<0.05),there was no significant difference at 5 min after drug onset and before drug administration(P>0.05).The scores of pain and restlessness of the Chinese version of N-PASS of the two groups decreased significantly 5 minutes after the onset of the drug, the decrease was greater in the observation group(P<0.05).There were 5 cases(9.43%) of adverse reactions in the control group and 3 cases(6.98%) in the observation group, there was no significant difference between the two groups(P>0.05).Conclusion:Compared with midazolam, dexmedetomidine can effectively accelerate the drug onset time, shorten the wake-up time after drug withdrawal, reduce the dosage of fentanyl, and has less impact on hemodynamic parameters and stress reaction of children, the adverse reactions is less.