摘要
目的分析芬太尼+咪达唑仑方案用于重症手足口病机械通气治疗患儿中的效果及其安全性。方法选取本院收治的130例重症手足口病患儿,均行机械通气治疗,采用随机数字表法将其分为两组65例,对照组采用咪达唑仑镇静治疗,观察组采用芬太尼联合咪达唑仑镇静治疗,比较两组的治疗情况、镇静效果、血流动力学指标,统计两组不良反应情况、镇静前和停药时患者的炎性因子变化。结果观察组咪达唑仑用量(39.56±16.28)mg/d少于对照组的(47.94±13.25)mg/d,机械通气时间(9.48±3.36)d和入住儿科重症监护病房(PICU)时间(11.73±4.29)d短于对照组的(12.05±5.92)d、(14.02±5.28)d(P<0.05);镇静前(t0)两组的Ramsay镇静评分比较无明显差异(P>0.05);观察组镇静后3h(t1)的Ramsay镇静评分(2.51±0.39)分、镇静后12h(t2)的Ramsay镇静评分(3.26±0.82)分高于对照组的(2.28±0.47)分、(2.94±0.63)分(P<0.05);镇静前(T0)两组患者的心率(HR)、平均动脉压(MAP)比较无明显差异(P>0.05);镇静后4h(T1)、镇静后8h(T2)和镇静后12h(T3)观察组的MAP、HR低于对照组(P<0.05);镇静前两组的血清抗肿瘤坏死因子(TNF-α)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)比较无显著差异(P>0.05);停药时观察组的TNF-α(14.15±3.72)ng/L、IL-6(18.47±4.58)ng/L、hs-CRP(8.57±1.14)mg/L低于对照组的(16.24±3.83)ng/L、(21.29±7.74)ng/L、(9.13±1.65)mg/L(P<0.05);观察组不良反应发生率(12.31%)低于对照组(26.15%)(P<0.05)。结论在重症手足口病患儿机械通气中应用芬太尼联合咪达唑仑能够有效提高镇静效果,促进患儿血压、心率水平恢复,减少麻醉药物用量,减少不良反应,抑制炎性反应,促进患儿尽快康复。
Objective To analyze the efficacy and safety of fentanyl+Midazolam protocol in the treatment of severe hand foot mouth disease in children with mechanical ventilation.Methods 130 children with severe hand foot mouth disease admitted to our hospital were treated with mechanical ventilation.They were randomly divided into two groups,65 cases.The control group was treated with Midazolam sedation,and the observation group was treated with fentanyl combined with Midazolam sedation.The treatment,sedation effect,hemodynamic indicators of the two groups were compared,and the adverse reactions,changes of inflammatory factors in patients before and after sedation were statistically analyzed.Results The dosage of Midazolam(39.56±16.28)mg/d in the observation group was less than that of the control group(47.94±13.25)mg/d,the time of mechanical ventilation(9.48±3.36)d and the time of admission to the pediatric intensive care unit(PICU)(11.73±4.29)d were shorter than that of the control group(12.05±5.92)d and(14.02±5.28)d(P<0.05);There was no significant difference in Ramsay sedation scores between the two groups before sedation(t0)(P>0.05);The Ramsay sedation score(2.51±0.39)at 3 hours after sedation(t1)and the Ramsay sedation score(3.26±0.82)at 12 hours after sedation(t2)in the observation group were higher than those in the control group(2.28±0.47)and(2.94±0.63)(P<0.05);There was no significant difference in heart rate(HR)and Mean arterial pressure(MAP)between the two groups before sedation(T0)(P>0.05);The MAP and HR of the observation group were lower than those of the control group at 4 hours(T1),8 hours(T2),and 12 hours(T3)after sedation(P<0.05);Serum anti-tumor necrosis factor(TNF)levels in the two groups before sedation-α),There was no significant difference in the levels of hypersensitive C-reactive protein(hs CRP)and interleukin-6(IL-6)(P>0.05);Observation group's TNF at discontinuation-αThe levels of(14.15±3.72)ng/L,IL-6(18.47±4.58)ng/L,and hs CRP(8.57±1.14)mg/L in the control group were lower than those in the control group(16.24±3.83)ng/L,(21.29±7.74)ng/L,and(9.13±1.65)mg/L(P<0.05);The incidence of adverse reactions in the observation group(12.31%)was lower than that in the control group(26.15%)(P<0.05).Conclusion The application of fentanyl combined with Midazolam in mechanical ventilation of children with severe hand foot mouth disease can effectively improve the sedative effect,promote the recovery of blood pressure and heart rate,reduce the amount of Narcotic,reduce adverse reactions,inhibit inflammatory reactions,and promote the recovery of children as soon as possible.
作者
徐锐
Xu Rui(Huanggang Hong'an People's Hospital,Huanggang 438400,Hubei Province,China)
出处
《罕少疾病杂志》
2023年第7期110-112,共3页
Journal of Rare and Uncommon Diseases
关键词
芬太尼
咪达唑仑
镇静
安全性
机械通气
重症手足口病
Fentanyl
Midazolam
Calm Down
Safety
Mechanical Ventilation
Severe Hand,Foot,and Mouth Disease
