摘要
目的：探讨咪达唑仑联合芬太尼用于婴幼儿先天性心脏病心内直视术后早期镇静镇痛的效果及对血流动力学和应激反应的影响。方法选取体外循环下心内直视矫治术后先天性心脏病患儿80例，随机分为试验组和对照组各40例。术后入监护室后，试验组经静脉持续输注咪达唑仑联合芬太尼，对照组间断注射咪达唑仑及芬太尼。统计2组体外循环时间、阻断主动脉时间、手术时间、呼吸机辅助时间，记录2组术前（t0）及术后1 h（t1）、4 h （t2）、8 h（t3）、12 h（t4）、16 h（t5）、20 h（t6）、24 h（t7）、36 h（t8）、48 h（t9）时的收缩压（SBP）、平均动脉压（MAP）、心率（HR）、呼吸（RR）、动脉血氧饱和度[Sa（O2）]及血糖、皮质醇、乳酸水平，记录t1~t4、t7~t9时点镇静镇痛评分及应用药物剂量、不良反应发生情况。结果试验组呼吸机辅助时间明显短于对照组（P＜0．05）。2组术后各时点HR均明显高于t0时（P均＜0．05），t3~t9时SBP、MAP及t8、t9时RR均高于t0时（P均＜0．05），各时点Sa（O2）比较差异均无统计学意义（P均＞0．05）。试验组t1、t5~t8时HR均显著低于对照组（P均＜0．05）；t2~t4时SBP、MAP均明显低于对照组（P均＜0．05），而同时点Sa（O2）明显高于对照组（P均＜0．05）；试验组t1、t2、t8时RR均明显低于对照组（P均＜0．05）。2组术后各时点血糖、皮质醇水平均明显高于t0时（P均＜0．05），t1~t3、t6~t9时乳酸水平明显高于t0时（P均＜0．05）；试验组t1~t4、t8时血糖水平，t2~t6时皮质醇水平，t2时乳酸水平均明显低于对照组（ P均＜0．05）。2组术后各时点Ramsay评分及FLACC评分比较差异均无统计学意义（P均＞0．05）。2组芬太尼用量比较差异无统计学意义（P＞0．05），但试验组咪达唑仑用量明显少于对照组（ P＜0．05）。2组均无明显不良反应发生。结�
Objective It is to explore the sedation analgesia effects of midazolam and fentanyl in early stage of open -heart surgery of congenital heart disease in infants and discuss their influence on hemodynamics and stress response .Methods Eighty children of open -heart surgery with cardiopulmonary bypass （ CPB ） were randomly divided into experimental group （group A,n=40） and control group（group B,n=40）.Midazolam and fentanyl were pumped by continous infusion for the group A, the group B were infused discontinuously with Midazolam and fentanyl .The systolic blood pressure （ SBP） ,mean ar-terial pressure （MAP）,heart rate （HR）, respiration （RR）,arterial oxygen saturation[Sa（O2）],blood glucose,cortisol, lac-tate were measured before operation （t0）, in 1h（t1）, 4h（t2）, 8h（t3）, 12h（t4）, 16h（t5）, 20h（t6）, 24h（t7）, 36h（t8）, 48h（t9） after operation respectively.The calm analgesic score, applied doses, side effects were recorded at t1-t4, t7-t9. Results There were significant differences in SBP ,ABP,Sa（O2）at T2~T4 （P〈0.05,HR at T1,T5~T8（P〈0.05,RR at T1,T2,T8（P〈0.05）between the two groups.The levels of cortisol, blood glucose of post -operation in both groups were higher than those of pre -operation at T1~T9 and lactate at T1~T3,T6~T9 ,too.The level of blood glucose at T 1~T4,T8 , cortisol at T2~T6 and lactate at T2 were lower than those of group B （P〈0.05）.The Ramsay,FALCC value and dosage of fentanyl were not different between the two groups （P〉0.05）.The dosage of midazolam in group A and mechanical ventilation time were less than that in groups B（P〈0.05）.No side effect was found in both groups.Conclusion Continuous infusion of small dose of midazolam and fentanyl can reduce stress response with less side effects and small influence of hemodynamic dis -turbance in early stage of open -heart surgery of congenital heart disease in infants .
出处
《现代中西医结合杂志》
CAS
2016年第22期2402-2405,2428,共5页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
2012年河北省医学科学研究重点课题计划基金资助项目(20120018)
关键词
咪达唑仑
芬太尼
镇静
镇痛
应激反应
midazolam
fentanyl
sedation
analgesia
stress response
