芬太尼联合咪达唑仑在早产儿机械通气中的镇静镇痛效果

Sedative and analgesic effects of fentanyl combined with midazolam in mechanical ventilation of premature infants

目的探讨芬太尼与咪达唑仑在早产儿机械通气中的镇静镇痛效果。方法选择2017年6月至2021年4月在南通大学附属医院新生儿病区接受机械通气治疗的呼吸窘迫综合征早产患儿90例,根据不同给药方案将患儿随机分为4组:F组(23例)静脉滴注芬太尼2μg·kg^(-1)·h^(-1);M组(23例)静脉滴注咪达唑仑0.1 mg·kg^(-1)·h^(-1);FM组(22例)联合使用芬太尼2μg·kg^(-1)·h^(-1)和咪达唑仑0.1 mg·kg^(-1)·h^(-1);FMH组(22例)联合使用芬太尼1μg·kg^(-1)·h^(-1)和咪达唑仑0.05 mg·kg^(-1)·h^(-1)。比较4组患儿用药前(0 h),用药后4 h、8 h、12 h、24 h的新生儿疼痛兴奋镇静量表(N-PASS)评分、吸气峰压(PIP)、吸入氧浓度(FiO2)、呼吸频率(RR)、心率(HR)、平均动脉压(MBP)、血糖(Glu);比较4组患儿机械通气时间、氧疗时间、住院时间、肠道足量喂养时间和短期药物不良反应。结果90例患儿用药不同时间点和不同组别的N-PASS评分、PIP、RR差异有统计学意义(P<0.05),存在时间和分组交互作用(P<0.05)。患儿用药不同时间点的FiO2、HR、MBP、Glu差异有统计学意义(P<0.05)。4组患儿间用药后不同时间点N-PASS评分差异均有统计学意义(P<0.05);FM组、FMH组不同时间点N-PASS评分均低于F组、M组(P<0.05)。4组患儿用药12 h、24 h时的PIP、RR差异有统计学意义(P<0.05);FM组、FMH组用药12 h、24 h时的PIP、RR均低于F组、M组(P<0.05)。4组患儿机械通气时间、氧疗时间、住院时间、肠道足量喂养时间及短期药物不良反应差异无统计学意义。结论芬太尼联合咪达唑仑应用于早产儿机械通气能有效减轻疼痛,降低RR,减少人机对抗的发生,但两药联用的最适宜剂量仍有待进一步研究。

Objective To explore the sedative and analgesic effects of fentanyl and midazolam in mechanical ventilation of premature infants.Methods 90 premature infants with respiratory distress syndrome who received mechanical ventilation in neonatal ward of the Affiliated Hospital of Nantong University from June 2017 to April 2021 were selected and randomly divided into four groups.After intubation,infants in group F(n=23)received intravenous infusion of fentanyl 2μg·kg^(-1)·h^(-1);those in group M(n=23)received intravenous infusion of midazolam 0.1 mg·kg^(-1)·h^(-1);those in group FM(n=22)received fentanyl 2μg·kg^(-1)·h^(-1)combined with midazolam 0.1 mg·kg^(-1)·h^(-1);those in group FMH(n=22)received fentanyl 1μg·kg^(-1)·h^(-1)combined with midazolam 0.05 mg·kg^(-1)·h^(-1).The neonatal pain,agitation and sedation scale(N-PASS)score,peak inspiratory pressure(PIP),inhaled oxygen concentration(FiO2),respiratory rate(RR),heart rate(HR),mean blood pressure(MBP),and blood glucose(Glu)were compared before and at 4,8,12 and 24 h after treatment.The duration of mechanical ventilation,oxygen therapy time,adequate enteral feeding time,length of hospital stay,and short-term side effects were compared among the four groups.Results There were significant differences in N-PASS score,PIP and RR among 90 infants at different time points and in different groups(P<0.05).There were significant differences in FiO2,HR,MBP,and Glu at different time points(P<0.05).After treatment,N-PASS score at 4,8,12 and 24 h in group FM and FMH were significantly lower than those in group F and M(P<0.05);PIP and RR at 12 and24 h in group FM and FMH were significantly lower than those in group F and M(P<0.05).There was no significant difference in the duration of mechanical ventilation,oxygen therapy time,hospital stay,adequate enteral feeding time and short-term side effects among the four groups.Conclusion Fentanyl combined with midazolam in mechanical ventilation of premature infants can effectively relieve pain,reduce RR,and reduce the occurrence of human-machine confrontation.However,the optimal dosage of fentanyl combined with midazolam remains to be further studied.