| 郑敏1 田刚1 李虎年2 刘勇2 王群1△.婴幼儿机械通气时使用右旋美托咪定和咪达唑仑的效果评价[J].,2012,12(12):2342-2348 |
| 婴幼儿机械通气时使用右旋美托咪定和咪达唑仑的效果评价 |
| Effect Evaluation of Dexmedetomidine and Midazolam in Infantsin Mechanical Ventilation |
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| DOI： |
| 中文关键词: 儿童 右旋美托咪定 机械通气 咪达唑仑 盐酸吗啡 镇静 |
| 英文关键词: Children Dexmedetomidine Mechanical ventilation Midazolam Morphine hydrochloride Sedation |
| 基金项目: |
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| 中文摘要: |
| 目的：比较婴幼儿在机械通气镇静时使用右旋美托咪定和咪达唑仑效果。方法：收集我院2009 年2 月至2011 年10 月入住
ICU 需要机械通气且镇静时间大于24h 的患儿60 例，随机分为3 组，每组20 例，右旋美托咪啶1 组（输注剂量为0.25 μg·kg-1·
h-1，D1 组）、2 组（输注剂量为0.5 μg·kg-1·h-1，D2 组）维持镇静，咪达唑仑组(输注剂量为0.05 mg·kg-1·h-1，M 组）维持镇静。同时根
据病情需要间断给予吗啡镇痛。镇静的疗效评估采用Ramsay 镇静评分以及脑电双屏指数（BIS）评价。结果：60 例患儿分为3 组，
每组20 例，咪达唑仑组（M 组）的输注持续时间（h）为22±8 h，0.25 μg (D1 组)和0.5 μg (D2 组)右旋美托咪啶组输注持续时间分
别为21±10 h 和22±9 h；M 组的平均输注速率为0.22±0.05 mg·kg-1·h-1，D1 组和D2 组平均输注速率分别为0.28±0.07 μg·kg-1·h-1
和0.21±0.05 μg·kg-1·h-1；三组差异无统计学意义。其中M 组、D1 组、D2 组使用吗啡的剂量是分别为36 mg·kg-1·24h-1、29 mg·kg-1·
24h-1 和20mg·kg-1·24h-1。D1 组与M 组使用吗啡的剂量差异无统计学意义。D2 组与M 组使用吗啡的剂量差异有统计学意义(P＜
0.05)。三组患儿BIS 值和Ramsay 评分监测差异无统计学意义。结论：右旋美托咪啶应用于婴幼儿是安全有效的，0.5 μg·kg-1·h-1
右旋美托咪啶组镇静更加有效，24 小时吗啡的使用剂量显著减少。 |
| 英文摘要: |
| Objective: To compare infants sedation effect and difference when using dexmedetomidine and midazolam in
mechanical ventilation. Methods: To collect ICU patients requiring mechanical ventilation from February 2009 to October 2011 in our
hospital, they received intravenously midazolam 0.05 mg·kg-1·h-1 dexmedetomidine 0.25 or 0.5 μg·kg-1·h-1 respectively. At the same
time, they were given interruptably morphine according to pathogenetic condition.We evaluate sedative effect using Ramsay sedation
scale and BIS. Results: Sixty patients were randomly assigned into three groups (n=20 for each group). Continuing infusion time in
midazolam group (group M), D1 group and D2 groups were 22±8h, 21±10h and 22±9h respectively. Average infusion rate in M, D1 and
D2 groups were 0.22 ±0.05 mg·kg-1·h-1h, 0.28 ±0.07 μg·kg-1·h-1 and 0.21 ±0.05 μg·kg-1·h-1respectively. There was no significant
difference among groups. The morphine dose in M, D1 and D2 groups were 36 mg·kg-1·24h-1, 29 mg·kg-1·24h-1 and 20 mg·kg-1·24h-1
respectively. Compared with Group M, the morphine dose in Group D1 decreased, but there was no significant difference (P>0.05).
However the morphine dose in Group D2 obviously decreased, there was significant difference compared with Group M(P<0.05).
Ramsay sedation scale and BIS value have no significant difference in three groups. Conclusion: Dexmedetomidine used in infant is safe
and effective, 0.5 μg·kg-1·h-1 dose of dexmedetomidine bring about effective sedation and decreased morphine dose in 24h significantly. |
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