CAJ | 학술논문

目的对比观察右旋美托咪啶和咪达唑仑联合芬太尼镇静治疗在先心病肺动脉高压( PAH)儿童术后的效果.方法 PAH术后患儿40例,根据计算机随机数字法,奇数入右旋美托咪啶治疗组(A组),偶数入咪达唑仑联合芬太尼治疗组(B组).A组右旋美托咪啶的负荷剂量为0.5～1.0 μg/kg,维持剂量为0.25～0.75 μg·kg-1 ·min- 1;B组咪达唑仑的负荷剂量为0.1 mg/kg,维持剂量为0.5～2.0μg· kg-1 ·min-1,芬太尼的维持剂量为1.0～1.5μg· kg-1·min-1.对比两组患儿镇静达标时间、机械通气时间、追加镇静药物的频次、谵妄发生率,用药前、用药后10 min、1h、4h、8h、12h的COMFORT评分、心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2)等指标变化.结果 A、B两组患儿用药后各个时间点的COMFORT评分均比用药前显著减低,差异均有统计学意义(P＜0.01),而用药后两组患儿各时间点之间的COMFORT评分比较差异无统计学意义.两组患儿的COMFORT评分、HR、MAP和SPO2在各时间点差异均无统计学意义.A组患儿追加镇静药物的频次显著低于B组患儿[(4.3±3.3)次对(10.7±5.5)次,P＜0.01].A组谵妄发生率显著低于B组(25％对60％),P＜0.05.两组患儿的镇静达标时间差异无统计学意义,A组患儿较B组机械通气时间短,但差异无统计学意义.结论与咪达唑仑联合芬太尼治疗相比较,单用右旋美托咪啶可在相同时间内达到满意的镇静效果,同时可以减少其他镇静药物的使用和谵妄的发生.
목적 대비관찰우선미탁미정화미체서륜연합분태니진정치료재선심병폐동맥고압( PAH)인동술후적효과.방법 PAH술후환인40례,근거계산궤수궤수자법,기수입우선미탁미정치료조(A조),우수입미체서륜연합분태니치료조(B조).A조우선미탁미정적부하제량위0.5～1.0 μg/kg,유지제량위0.25～0.75 μg·kg-1 ·min- 1;B조미체서륜적부하제량위0.1 mg/kg,유지제량위0.5～2.0μg· kg-1 ·min-1,분태니적유지제량위1.0～1.5μg· kg-1·min-1.대비량조환인진정체표시간、궤계통기시간、추가진정약물적빈차、섬망발생솔,용약전、용약후10 min、1h、4h、8h、12h적COMFORT평분、심솔(HR)、평균동맥압(MAP)、혈양포화도(SPO2)등지표변화.결과 A、B량조환인용약후각개시간점적COMFORT평분균비용약전현저감저,차이균유통계학의의(P＜0.01),이용약후량조환인각시간점지간적COMFORT평분비교차이무통계학의의.량조환인적COMFORT평분、HR、MAP화SPO2재각시간점차이균무통계학의의.A조환인추가진정약물적빈차현저저우B조환인[(4.3±3.3)차대(10.7±5.5)차,P＜0.01].A조섬망발생솔현저저우B조(25％대60％),P＜0.05.량조환인적진정체표시간차이무통계학의의,A조환인교B조궤계통기시간단,단차이무통계학의의.결론 여미체서륜연합분태니치료상비교,단용우선미탁미정가재상동시간내체도만의적진정효과,동시가이감소기타진정약물적사용화섬망적발생.
Objective To compare dexmedetomidine with midazolam/fentanyl for sedation in children with pulmonary artery hypertension(PAH) after congenital cardiac surgery.Methods Forty children with PAH were randomly divided into two groups after congenital cardiac surgery.The age of children ranged from 3 to 89 months,and weight ranged from 3 to 26 kg.Group A received an infusion of dexmedetomidine(Dex) 0.5 - 1.0 μg/kg bolus for induction,then a maintenance dose of Dex 0.25 - 0.75 μg · kg- 1 · h - 1.Group B received an infusion of midazolam 0.1 mg/kg bolus for induction,then a maintenance dose of 0.5-2.0 μg·kg-1 ·min-1.The maintenance dose offentanyl was 1.0-1.5 μg·kg-1 · h-1.The time of target sedation score,duration of mechanical ventilation,frequency of using other sedatives and prevalence of delirium were compared between the two groups. Other indicators including COMFORT scale,heart rate ( HR),mean arterial pressure (MAP) and pulse oxygen saturation ( SPO2 ) were compared between the two groups among following time points:before infusion,10 min,1 h,4 h,8 h,12 h after infusion.Results Time points after infusion had lower COMFORT scale significantly compared with time points before infusion(26.3 ± 7.3 ) in group A ( P ＜0.01 ),so as in group B while the COMFORT scale was 23.9 ± 5.9 before infusion.There was no statistics difference of the time to reach the target sedation score between group A and group B [ (4.4 ± 1.5 ) min vs (4.3 ± 1.9 ) min,P ＞ 0.05].The COMFORT scale had no statistic difference among the time points after infusion in the two groups.The COMFORT scale,HR,MAP and SPO2 had no statistic difference between goup A and goup B among time points before and after infusion.Frequency of using other sedatives were significantly lower in group A compare with group B (4.3 ± 3.3 vs 10.7 ± 5.5 ) ( P ＜ 0.01 ).The prevalence of delirium was significantly lower in group A than group B (25％ vs 60％ ) ( P ＜ 0.05).The duration of mechanical ventilation was lower in group A compare with group B [ (40.9 ± 22.3) h vs (46.1 ± 23.1 ) h] but there was no statistics difference.Conclusion Compare with midazolam/fentanyl,single use of dexmedetomidine had sound therapeutic effects to provide sedation for children with PAH,while the latter could decrease the frequency of using other sedatives and prevalence of delirium.