咪达唑仑联合瑞芬太尼治疗破伤风患者痉挛的疗效

Efficacy of midazolam combined with remifentanil in control of spasm in patients with tetanus

目的评价咪达唑仑联合瑞芬太尼治疗成人破伤风患者痉挛的效果。方法选取第三军医大学大坪医院急诊科2012年7月至2015年11月收治的22例成人破伤风患者,其中男性13例,女性9例;年龄22~64岁,平均年龄(43±6)岁进行回顾性研究。所有患者均经中心静脉通路,先后持续微量泵入咪达唑仑和盐酸瑞芬太尼进行复合镇静、镇痛治疗。观察患者用药前和用药后2,6,12,24 h体温(T)、呼吸频率(R)、心率(HR)、血压(BP)、脉搏血氧饱和度(SpO_2)、中心静脉压(CVP)的变化,以及治疗后1,2,3,7,10,14,18 d痉挛发作次数及持续时间、Ramsay镇静评分、张口大小等指标。结果所有患者平均治疗时间(13.5±3.2)d。平均Ramsay评分为(3.2±1.3)分,随着治疗时间的增加,患者治疗后第1天至第18天平均痉挛发作频率由(45.5±9.6)次/min逐渐降低至(2.1±0.8)次/min,持续时间由(23.6±11.8)s逐渐缩短至(2.5±1.0)s,张口程度由(0.7±0.2)cm逐渐增大至(3.5±1.6)cm,差异有统计学意义(P均<0.05)。与治疗前相比,治疗后BP下降、HR减缓,差异有统计学意义(P<0.05)。但治疗前后R和CVP的差异无统计学意义(P>0.05)。22例患者全部治愈出院,无死亡及并发症发生。结论咪达唑仑联合瑞芬太尼持续静脉泵入是治疗中、重度破伤风患者痉挛安全、有效用药可达到理想的镇静、镇痛和控制痉挛的效果。

Objective To investigate the efficacy of midazolam combined with remifentanil in treatment of spasm in adult patients with tetanus.Methods A total of 22 cases of adult tetanus patients treated from July 2012 to November 2015 were enrolled in the study.The patients were treated by continuous micro pump infusion of midazolam combined with remifentanil for sedation and analgesia.The changes of vital signs,the frequency and duration of spasm,the Ramsay sedation score and the size of mouth opening were observed before and after treatment.Results All patients were treated for an average( 13.5±3.2)days,mean Ramsay sedation score( 3.2±1.3) points.Compared with before and after treatment,the seizure frequency was significantly reduced,the duration was significantly shorter,and the mouth opening was increased gradually( P > 0.05).Decreased blood pressure and heart rate were significantly decreased( P < 0.05).Respiratory and CVP changes were not significant before and after treatment( P > 0.05).All patients were cured.There was not any severe complication or death in this study.Conclusion A continuous intravenous infusion of midazolam combined with remifentanil,under a strict monitoring,provides a safe and effective method on the spasm control treatment for tetanus patients.Rational use of this treatment can achieve an ideal sedation,analgesia and spasm control effect.