CAJ | 학술논문

目的探讨咪达唑仑消除新生儿机械通气中出现的人-机对抗的临床价值.方法选择2006年7月至2012年6月收治于我院新生儿科的需要机械通气的出现入-机对抗的新生儿病例83例,并依据是否使用咪达唑仑将患儿分为2组:对照组43例常规给予安定、苯巴比妥类和水合氯醛等镇静处理；观察组40例使用咪达唑仑镇静.对比两组患儿呼吸机参数、脱管率、应用机械通气时间、镇静评分,并进行统计学分析.结果观察组使用眯达唑仑后吸气峰压由(25.2±0.6) cm H2O(1 cmH2O=98 Pa)下调至(19.2±0.7) em H2O,对照组由(24.7±0.5) cm H2O下调至(21.3 ±0.9) em H20,下调明显,差异有统计学意义(P＜0.05).观察组氧浓度由(65.5±0.5)％下调至(40.6±0.7)％,对照组由(66.4±0.4)％下调至(62.4±0.6)％,下调明显,差异有统计学意义(P＜0.05).观察组无1例患儿因烦躁导致脱管,对照组有11例,差异有统计学意义(P＜0.05).观察组应用机械通气时间(79.3± 15.5)h,,对照组(101.3±16.3)h,两组比较差异有统计学意义(t=2.9,P＜ 0.01).用药前,观察组与对照组的镇静评分差异无统计学意义(P＞0.05),观察组应用咪达唑仑后0.5、1、2、24 h无操作时与对照组应用安定、苯巴比妥及/和水合氯醛等维持镇静的评分差异均有统计学意义(P＜0.05).结论持续静脉滴注咪达唑仑能有效减轻机械通气治疗过程中的不适感,减少生理应激反应,达到自主呼吸与呼吸机协调同步,改善通气,稳定血氧饱和度.
목적 탐토미체서륜소제신생인궤계통기중출현적인-궤대항적림상개치.방법 선택2006년7월지2012년6월수치우아원신생인과적수요궤계통기적출현입-궤대항적신생인병례83례,병의거시부사용미체서륜장환인분위2조:대조조43례상규급여안정、분파비타류화수합록철등진정처리；관찰조40례사용미체서륜진정.대비량조환인호흡궤삼수、탈관솔、응용궤계통기시간、진정평분,병진행통계학분석.결과 관찰조사용미체서륜후흡기봉압유(25.2±0.6) cm H2O(1 cmH2O=98 Pa)하조지(19.2±0.7) em H2O,대조조유(24.7±0.5) cm H2O하조지(21.3 ±0.9) em H20,하조명현,차이유통계학의의(P＜0.05).관찰조양농도유(65.5±0.5)％하조지(40.6±0.7)％,대조조유(66.4±0.4)％하조지(62.4±0.6)％,하조명현,차이유통계학의의(P＜0.05).관찰조무1례환인인번조도치탈관,대조조유11례,차이유통계학의의(P＜0.05).관찰조응용궤계통기시간(79.3± 15.5)h,,대조조(101.3±16.3)h,량조비교차이유통계학의의(t=2.9,P＜ 0.01).용약전,관찰조여대조조적진정평분차이무통계학의의(P＞0.05),관찰조응용미체서륜후0.5、1、2、24 h무조작시여대조조응용안정、분파비타급/화수합록철등유지진정적평분차이균유통계학의의(P＜0.05).결론 지속정맥적주미체서륜능유효감경궤계통기치료과정중적불괄감,감소생리응격반응,체도자주호흡여호흡궤협조동보,개선통기,은정혈양포화도.
Objective To explore the clinical value of midazolam in elimination of man-machine confrontation in neonatal mechanical ventilation.Methods The neonates who developed man-machine confrontation in mechanical ventilation during July 2006 to June 2012 were restropectively reviewed.According to whether or not use midazolam,the neonates were divided into two groups.The control group (43 neonates) received conventional valium,barbiturate,and chloral hydrate; while the study group (40 neonates) received midazolam for sedation.Parameters of the ventilator,rate of tube removal,duration of mechanical ventilation,and scores for sedation were compared between the two groups and then statistically analyzed.Results The down-regulation of peak inspiratory pressure differed significantly between the study group and the control group (from 25.2 ± 0.6 cm H2O to 19.2 ± 0.7 cm H2O vs.from 24.7 ± 0.5 cm H2O 21.3 ± 0.9 cm H2O,P＜0.05).The oxygen concentration declined from (65.5 ±0.5) ％ to (40.6 ±0.7)％ in the study group,and from (66.4 ± 0.4) ％ to (62.4 ± 0.6)％ in the control group,with a statistical difference (P＜0.05).No tube removal occurred due to agitation in the study group but occurred in 11 neonates in the control group (P＜0.05).The duration of mechanical ventilation was shorter in the study group [(79.3 ± 15.5)h] than in the control group [(101.3 ± 16.3)h],with a statistical difference (t=2.9,P＜0.01).The scores for sedation did not differ statistitally between the two groups before uses of medication (P＞0.05),and they differed significantly 0.5,1,2,and 24 h after uses of the related medications (P＜0.05).Conclusions Continuous intravenous infusion of midazolam can effectively relieve the discomfort during mechanical ventilation and reduce physiological stress response to gain synchronization of spontaneous breathing and ventilator,improve ventilation,and stablize blood oxygen saturation.