CAJ | 학술논문

目的探讨咪达唑仑对消除在新生儿机械通气中出现的人-机对抗的临床价值.方法回顾性总结2006年7月至2012年6月在我院新生儿科收住的需要机械通气的出现人-机对抗新生儿病例,并依据是否使用咪达唑仑随机将患儿分为2组:对照组43例给予常规安定、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.总结对比两组患儿:(1)呼吸机参数；(2)脱管率；(3)应用机械通气时间；(4)镇静评分,并进行分析.结果观察组用咪达唑仑后吸气峰压由(25.2±0.6)cm H2O下调至(19.2±0.7) cmH2O,与对照组(24.7±0.5) cm H2O下调至(21.3±0.9)cm H2O对比,下调明显,差异有统计学意义(P＜0.05).氧浓度由(65.5±0.5)％下调至(40.6±0.7)％,与对照组由(66.4±0.4)％下调至(62.4±0.6)％对比,下调明显,差异有统计学意义(P＜0.05).观察组无一例因患儿烦躁导致脱管,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明显少于对照组(101.3±16.3)h,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 탐토미체서륜대소제재신생인궤계통기중출현적인-궤대항적림상개치.방법 회고성총결2006년7월지2012년6월재아원신생인과수주적수요궤계통기적출현인-궤대항신생인병례,병의거시부사용미체서륜수궤장환인분위2조:대조조43례급여상규안정、분파비타류화수합록철등진정처리；관찰조40례사용미체서륜진정.총결대비량조환인:(1)호흡궤삼수；(2)탈관솔；(3)응용궤계통기시간；(4)진정평분,병진행분석.결과 관찰조용미체서륜후흡기봉압유(25.2±0.6)cm H2O하조지(19.2±0.7) cmH2O,여대조조(24.7±0.5) cm H2O하조지(21.3±0.9)cm H2O대비,하조명현,차이유통계학의의(P＜0.05).양농도유(65.5±0.5)％하조지(40.6±0.7)％,여대조조유(66.4±0.4)％하조지(62.4±0.6)％대비,하조명현,차이유통계학의의(P＜0.05).관찰조무일례인환인번조도치탈관,대조조유11례,차이유통계학의의(P＜0.05).관찰조응용궤계통기시간(79.3±15.5)h명현소우대조조(101.3±16.3)h,차이유통계학의의(t=2.9,P＜ 0.01).용약전관찰조여대조조적진정평분차이무통계학의의(P＞0.05),관찰조응용미체서륜후0.5、1、2、24 h무조작시여대조조응용안정、분파비타급/화수합록철등유지진정적평분차이균유통계학의의(P＜0.05).결론 지속정맥적주미체서륜능유효감경궤계통기치료과정중적불괄감,감소생리응격반응,체도자주호흡여호흡궤협조동보,개선통기,은정혈양포화도.
Objective To discuss the clinical value of midazolam in eliminating the man-machine against of newborn mechanical ventilation.Methods We retrospectively summarized the neonatal cases from July 2006 to June 2012 in our neonatology department with need of mechanical ventilation but having man-machine against,on the basis of whether to use midazolam we randomly divided them into two groups:43 cases in control group with conventional stability,phenobarbital class and chloral hydrate and calm processing; 40 cases of the observation group used midazolam.Two groups were compared with each other as follows:①breathing machine parameters; ②rate of taking off the tube;③the application of mechanical ventilation time; ④calm score.Then we carried on the analysis.Results The observation group with midazolam after suction peak voltage from (25.2 ± 0.6) cm H2O down to (19.2 ± 0.7) cm H2O,compared with (24.7 ± 0.5) cm H2O down to (21.3 ± 0.9) cm H2O in the control group,difference had statistical significance (P＜0.05).Oxygen concentration was (65.5 ± 0.5)％ down to (40.6 ± 0.7)％,and the control group was (66.4 ± 0.4)％ down to (62.4 ± 0.6)％ as contrast,cut obvious,difference had statistical significance (P＜0.05).There was no case of taking off the tube because of being agitated in the observation group,but the control group had 11 cases (P＜0.05).Application of mechanical ventilation time of the observation group was (79.3 ± 15.5) hours,less than that of control group of (101.3 ± 16.3) hours,the difference was statistically significant (t=2.9,P＜0.01).Before using this drug observation group and control group calm score difference was not statistically significant (P＞0.05),application midazolam after 0.5,1,2 and 24 hours in the observation group with no operation were compared to those of control application stability,phenobarbital and/or chloral hydrate and maintaining calm score differences showed statistically significance (P＜0.05).Conclusion Continuous intravenous drip midazolam can effectively reduce the mechanical ventilation in the course of treatment and discomfort,reduce the physiological stress response to spontaneous breathing and breathing machine coordinate synchronous,improve ventilation,and stable blood oxygen saturation.