摘要
目的:探讨右美托咪定联合床边超声技术在儿童机械通气治疗中的应用价值。方法:选取2018年至2021年无锡市儿童医院重症监护室收治的机械通气患儿52例,进行回顾性分析比较。对照组29例使用咪达唑仑镇静,观察组23例使用右美托咪定镇静并联合每日床边超声评估,其他治疗不变。比较和分析两组患儿初始镇静达到目标评分的时间、48小时后的镇静评分,机械通气24小时后鼻饲喂养耐受情况,呼吸机相关性肺炎发生率、呼吸机治疗天数、死亡率、血流动力学指标(心率、血压)等数据。结果:对照组和观察组比较结果显示,年龄、性别、P/F值以及小儿危重症评分均无统计学差异,P>0.05;初始镇静治疗达到目标镇静评分的时间相比〔(76±16.73)s vs(55.65±10.14)s〕,P>0.05;维持镇静24小时后,喂养耐受率相比(62.1%vs 82.6%),P<0.05;48小时镇静后RASS评分≤0分的比例相比〔51.7%vs 86.9%〕,P<0.05;呼吸机治疗天数相比〔(8.21±3.68)d vs(5.08±2.19)d〕,P<0.05;撤药后的烦躁发生率相比(27.6%vs 4.3%),P<0.05;两组的VAP发生率、死亡率、血流动力学指标相比,均无明显统计学差异,P>0.05。结论:使用右美托咪定联合每日床边超声技术有助于儿童机械通气时的镇静和气道护理,能改善患儿的舒适度和喂养耐受情况,减少呼吸机治疗天数。
Objective:To investigate the application value of dexmedetomidine combined with bedside ultrasound in the treatment of mechanical ventilation in children.Methods:52 children with mechanical ventilation admitted to the Intensive care Unit of Wuxi Children’s Hospital from 2018 to 2021 were retrospectively analyzed and compared.Twenty-nine patients in the control group were sedated with midazolam,while 23 patients in the observation group were sedated with dexmedetomidine combined with daily bedside ultrasound assessment.Other treatments remained unchanged.The time of initial sedation to reach the target score,sedation score 48 hours later,nasal feeding tolerance 24 hours after mechanical ventilation,incidence of ventilator-associated pneumonia,days of ventilator treatment,mortality,hemodynamic indexes(heart rate,blood pressure)and other data of the two groups were compared and analyzed.Results:The comparison between the control group and the observation group showed that there were no significant differences in age,gender,P/F value and critical illness score of children,P>0.05;The time of initial sedation to achieve the target sedation score was compared with(76±16.73)s vs(55.65±10.14)s,P>0.05.After 24 hours of sedation,the feeding tolerance rate was compared with 62.1%vs 82.6%,P<0.05;The ratio of RASS score≤0 after 48 hours of sedation(51.7%vs 86.9%),P<0.05;Compared with(8.21±3.68)d vs(5.08±2.19)d,P<0.05;The incidence of dysphoria after withdrawal was compared with 27.6%vs 4.3%,P<0.05;There were no significant differences in the incidence,mortality and hemodynamic indexes of VAP between the two groups(P>0.05).Conclusions:The use of dexmedetomidine combined with daily bedside ultrasound technology is helpful for sedation and airway care during mechanical ventilation in children,and can improve the comfort and feeding tolerance of children,and reduce the number of days of ventilator treatment.
作者
蒋蕾花
吴峤微
华燕萍
惠璧君
诸澎伟
JIANG Leihua;WU Qiaowei;HUA Yanping;HUI Bijun;ZHU Pengwei(Intensive Care Unit,Wuxi Children’s Hospital,Wuxi 214000,China)
基金
不同卧位在婴幼儿重症肺炎高频振荡排痰中的应用研究,编号:NMUB2019285。
关键词
右美托咪定
床旁超声
儿童
机械通气
dexmedetomidine
Bedside ultrasound
Children
Mechanical ven tilation
