摘要
目的 探讨顺阿曲库铵在消除小儿机械通气中人-机对抗的疗效与安全性.方法 选取2010年12月-2012年12月我院收治的54例机械通气中发生人-机对抗的≥2岁的患儿,将其随机分为对照组（29例）和观察组（25例）.对照组给予咪达唑仑负荷量0.1 mg/kg,0.9%氯化钠注射液5～10 ml稀释后静脉注射,继以0.05 mg·kg-1·h-1用5%葡萄糖或0.9%氯化钠注射液稀释后输液泵静脉维持;观察组给予顺阿曲库铵负荷量0.1 mg/kg,0.9%氯化钠注射液5～10 ml稀释后静脉注射,继以0.06～0.12 mg·kg-1·h-1用5%葡萄糖或0.9%氯化钠注射液稀释后输液泵静脉维持.比较两组治疗后（用药2 h后）的血气分析结果、心率、呼吸、血压、氧合指数（OI）、平均气道压（MAP）、血氧饱和度（SpO2）;计算两组患儿治疗后人-机对抗解除有效率,比较药物起效时间、停药后自主呼吸恢复时间及维持用药时间;观察不良反应与预后.结果 治疗后观察组患儿动脉血二氧化碳分压（PaCO2）、MAP低于对照组,OI、SpO2高于对照组（P＜0.05）;且观察组患儿人-机对抗解除有效率（100.0%,25/25）高于对照组（79.3%,23/29）,药物起效时间[（2.3±0.5）min]、停药后自主呼吸恢复时间[（5.9±2.0）min]则短于对照组[（5.5±1.0）、（42.1±7.5）min]（P＜0.05）.两组均无一例发生血压下降;其中观察组死亡1例（4.0%）,对照组死亡3例（10.3%）,两组病死率间差异无统计学意义（P＞0.05）.结论 应用顺阿曲库铵消除≥2岁的小儿机械通气中人-机对抗是高效、安全的.
Objective To discuss the effect and security of cisatracurium in ehminating patient - ventilator asynchrony during mechanical ventilation in children. Methods A total of 54 children at the age of 2 or more with patient - ventilator asyn- chrony during the process of medical ventilation in our hospital from December 2010 to December 2012 were enrolled in our study and randomly divided into the the control group （n ： 29 ） and observation group （n = 24） . The control group were given 0. 1 mg/kg of midazolam dissolved in 5 to 10 ml of 0.9% sodium chloride injection by intravenous injection, and then they were given with a maintaining dose of 0. 05 mg/kg of midazolam per hour dissolved in 5% glucose or 0. 9% sodium chloride injection through infusion pump ; While the observation group were given 0. 1 mg/kg of cisatracurium dissolved in 5 to 10 ml of 0. 9% sodium chlo- ride injection by intravenous injection, and then they were given a maintaining dose of 0.06 to 0. 12 mg/kg of cisatracurium per hour dissolved in 5% glucose or 0.9% sodium chloride injection through infusion pump. The blood gas, heart rate （HR） , re- spiratory rate （RR）, blood pressure （BP）, oxygenation index （OI）, mean airway pressure （MAP）, and oxyhemoglobin sat- uration （ SpO2 ） were collected after 2 - hour treatment. The onset time of the drugs, the time to restore spontaneous breathing af- ter ending treatment and the effective rate of eliminating patient - ventilator asynchrony were analyzed. The adverse drug reactions and prognosis were also observed. Results After treatment, PaCO2 and MAP in the observation group were significantly lower than those in the control group, while OI and SpO： in the observation group were significantly higher than those in the control group （ P 〈 0. 05 ） . The effective rate of the observation group （ 100. 0%, 25/25 ） was higher than that of the control group （79. 3%, 23/29） （P 〈0. 05）, while the onset time of the drug and the time to restore spontaneous breathing in the observationgroun [ （2. 3±0. 5） rain and （5.9 ±2. 0） minl were significantlv shorter than those in the control group f （5.5 ± 1. O） minand （42. 1 ± 7.5 ） min, P 〈 O. 013 . No decrease in blood pressure was noted in both groups. There were 1 （4. 0% ） death in the observation group and 3 （ 10. 3% ） deaths in the control group, and the difference in death rate between two groups was not statistically significant （ P 〉 0. 05 ） . Conclusion Cisatracurium works efficiently and safely in eliminating patient - ventilator asynchrony during the process of mechanical ventilation among children at the age of 2 or more.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第36期4268-4271,共4页
Chinese General Practice
关键词
呼吸
人工
咪达唑仑
顺阿曲库铵
人-机对抗
Respiration, artificial
Midazolam
Cisatracurium
Patient - ventilator asynchrony
