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目的:观察吗啡治疗重症手足口病并神经源性肺水肿(NPE)的镇静效果。方法:63例手足口病合并NPE患儿,行常规治疗与机械通气后随机分为两组,其中咪达唑仑组36例,吗啡组27例。咪达唑仑负荷量0.1 mg/kg,用生理盐水5～10 mL稀释后静脉推注,继以0.05～0.15 mg/(kg.h)输液泵静脉维持推注。吗啡负荷量0.05～0.1 mg/kg,用生理盐水5 mL稀释后静脉推注,继以吗啡10～40μg/(kg.h)输液泵静脉维持推注。比较两组用药期间血气分析、心率(HR)、呼吸(RR)、血压(BP)、血氧饱和度(SpO2)、氧合指数(OI)、平均气道压(MAP);观察两组患儿对镇静药物起效时间、达到满意镇静深度时间、上机时间。结果:吗啡组达到理想镇静水平的例数多于咪达唑仑组(P<0.05),吗啡组pH、HR、RR、SpO2、OI及MAP均较咪达唑仑组改善明显(P<0.05或P<0.01);吗啡组对药物起效时间、达到满意镇静深度时间、上机时间均少于咪达唑仑组(P<0.01)。结论:吗啡在手足口病并神经源性肺水肿治疗中的镇静效果好,在NPE患儿的镇静治疗中应优先考虑选择吗啡。
Objective: To observe the sedation effect of morphine on severe hand-foot-mouth disease and neurogenic pulmonary edema (NPE). Methods: Sixty-three HFMD patients with NPE were randomly divided into two groups: conventional therapy and mechanical ventilation, 36 in midazolam group and 27 in morphine group. Midazolam loading 0.1 mg / kg, diluted with saline 5 ~ 10 mL after intravenous injection, followed by intravenous infusion of 0.05 ~ 0.15 mg / (kg.h) infusion to maintain. Morphine loading was 0.05-0.1 mg / kg. The mice were infused intravenously with 5 mL of normal saline and intravenous infusion of morphine (10-40 μg / (kg.h)). The blood gas analysis, heart rate, respiration, blood pressure, SpO2, OI, Pediatric sedation medication onset time to achieve satisfactory sedation depth time, on the machine time. Results: Compared with midazolam group, morphine group had more ideal sedation than midazolam group (P <0.05), and morphine group had better pH, HR, RR, SpO2, OI and MAP than the midazolam group Or P <0.01). The onset time of the drug in morphine group was shorter than the midazolam group (P <0.01). CONCLUSIONS: Morphine has a good sedative effect in the treatment of hand, foot and mouth disease and neurogenic pulmonary edema. Morphine should be given priority in the sedation treatment of children with NPE.