右美托咪定与咪达唑仑对机械通气患儿膈肌功能及撤机结果的影响

Effects of dexmedetomidine and midazolam on diaphragm function and withdrawal result in children patients with mechanical ventilation

目的研究右美托咪定与咪达唑仑对机械通气患儿膈肌功能及撤机结果的影响。方法选取2021年1月1日至2022年1月31日该院儿童重症监护室行机械通气的学龄前肺炎患儿64例,采用随机数字表法分为右美托咪定组(Y组)和咪达唑仑组(M组),每组各32例。Y组和M组在芬太尼镇痛的基础上分别使用右美托咪定和咪达唑仑镇静,撤机拔管前进行自主呼吸试验。在2组上机后1 h(T1)及首次自主呼吸试验5 min时(T2)使用超声进行膈肌功能评估;比较2组T1、T2的膈肌移动度、膈肌增厚分数;比较2组芬太尼用量、首次撤机成功率、撤机后呼吸抑制发生率、谵妄发生率。结果T1时,Y组、M组的膈肌移动度分别为(1.04±0.12)、(1.07±0.15)mm,膈肌增厚分数分别为(24.5±5.0)%、(15.7±3.6)%;T2时,Y组、M组的膈肌移动度分别为(0.95±0.11)、(0.84±0.09)mm,膈肌增厚分数分别为(15.7±3.6)%、(13.1±3.3)%。与T1比较,T2时Y组、M组膈肌移动度、膈肌增厚分数均降低,差异有统计学意义(P<0.001)。与M组比较,T2时Y组膈肌移动度、膈肌增厚分数均降低,差异有统计学意义(P<0.05)。与M组比较,Y组芬太尼使用量降低[(1.45±0.15)mg vs.(2.23±0.34)mg,P<0.001],首次撤机成功率增加(93.3%vs.73.3%,P=0.038),机械通气时间降低[(5.6±1.1)d vs.(6.3±1.0)d,P=0.01],撤机后呼吸抑制发生率减少(3.3%vs.16.7%,P=0.005)、谵妄等不良反应发生率减少(0 vs.20.0%,P=0.035)。结论机械通气患儿使用右美托咪定能降低膈肌功能影响,减少镇痛药物用量,提高首次撤机成功率,减少撤机后不良反应。

Objective To investigate the effects of dexmedetomidine and midazolam on the diaphragm function and withdrawal result in children patients with mechanical ventilation.Methods Sixty-four preschool children patients with pneumonia undergoing mechanical ventilation in the pediatric ICU of this hospital from January1,2021 to January 31,2022 were selected and divided into the dxmedetomidine group(Y group)and midazolam group(M group)by adopting the random number table method,32 cases in each group.On the basis of fentanyl analgesia,the Y group and M group used dexmedetomidine and midazolam for sedation respectively,and conducted the spontaneous breathing test before the ventilator withdrawing and extubation.The diaphragm function in the two groups was evaluated by ultrasound at 1 h after ventilation(T1)and 5 min(T2)after the first spontaneous breathing test;the diaphragmatic mobility and thickening score at T1 and T2 were compared between the two groups;the dosage of fentanyl,success rate of first ventilator weaning,incidence rate of respiratory depression after ventilator weaning and the incidence rate of delirium were compared between the two groups.Results The diaphragmatic mobilities at T1 in the Y group and M group were(1.04±0.12)mm and(1.07±0.15)m m,the diaphragm thickening scores were(24.5±5.0)%and(15.7±3.6)%respec-tively;the diaphragmatic mobilities at T2 in the Y group and M group were(0.95±0.11)mm and(0.84±0.09)mm respectively,and the diaphragm thickening scores were(15.7±3.6)%and(13.1±3.3)%respectively.The diaphragmatic mobilities and diaphragm thickening scores at T2 in the Y group and M group all were decreased compared with those at T1,and the differences were statistically significant(P<0.001).Compared with the M group,the diaphragmatic mobilities and diaphragm thickening scores at T2 in the Y group were decreased,and the differences were statistically significant(P<0.05).Compared with the M group,the use amount of fentanyl in the Y group was decreased[(1.45±0.15)mg vs.(2.23±0.34)mg,P<0.001],the success rate of first ventilator withdrawal was increased(93.3%vs.73.3%,P=0.038],the time of mechanical ventilation was decreased[(5.6±1.1)d vs.(6.3±1.0)d,P=0.01],the incidence rate of respiratory depression after ventilator withdrawal was decreased(3.3%vs.16.7%,P=0.005],and the incidence rate of adverse reactions such as delirium was decreased(0 vs.20.0%,P=0.035).Conclusion The use of dexmedetomidine in the children patients with mechanical ventilation could decrease the influence on the diaphragm function,reduce the dosage of analgesic drugs,increase the success rate of first ventilator weaning,and reduce the adverse reactions after ventilator weaning.