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目的:观察持续静脉注射咪达唑仑联合静脉注射芬太尼在儿科重症监护病房(PICU)机械通气患儿中镇静、镇痛的临床效果。方法:将我院PICU行机械通气的患儿40例,随机分为持续静脉注射咪达唑仑组(M组)20例和持续静脉注射咪达唑仑联合静脉注射芬太尼组(M+F组)20例,维持镇静深度Ramsay评分3～4级,观察相关指标。结果:两组患儿镇静效果比较差异无统计学意义(P>0.05),镇静48 h时咪达唑仑药物总量M+F组为(85.3±7.8)μg/kg,低于M组的(115.8±9.6)μg/kg,两组比较差异有统计学意义(P<0.05)。两组患儿停药后完全清醒(Ramsay 2级以上)的时间均在60 min左右,两组比较差异无统计学意义(P>0.05)。患儿机械通气时间M+F组为(91±15)min,短于M组的(120±19)min,而且心率、呼吸及氧合指数改善较M组更明显,两组比较差异有统计学意义(P<0.05)。结论:持续静脉注射咪达唑仑联合静脉注射芬太尼能发挥很好的镇静、镇痛效果。
Objective: To observe the clinical effect of continuous intravenous midazolam combined with intravenous injection of fentanyl in sedation and analgesia in pediatric intensive care unit (PICU) with mechanical ventilation. Methods: Forty children with PICU undergoing mechanical ventilation were randomly divided into continuous intravenous midazolam group (M group) and continuous intravenous midazolam plus intravenous fentanyl group (M + Group F) 20 cases, maintaining the depth of sedation Ramsay score 3 to 4, to observe the relevant indicators. Results: There was no significant difference in sedation between the two groups (P> 0.05). After 48 h of sedation, the total amount of midazolam in M + F group was (85.3 ± 7.8) μg / kg, which was lower than that in M group (115.8 ± 9.6) μg / kg, the difference between the two groups was statistically significant (P <0.05). Both groups were fully awake (Ramsay level 2 or above) for 60 minutes after stopping the treatment, with no significant difference between the two groups (P> 0.05). The mechanical ventilation time in M + F group was (91 ± 15) min, shorter than that in M group (120 ± 19) min, and the improvement of heart rate, respiration and oxygenation index were more obvious than those in M group Significance (P <0.05). CONCLUSION: Continuous intravenous midazolam combined with intravenous injection of fentanyl exerts a good sedative and analgesic effect.