目的：探讨芬太尼对机械通气下新生儿镇痛改善作用及不良反应。方法选取2010年3月-2011年2月在新生儿科重症监护室出生24 h内的78例经胸部X线片检查确诊为呼吸窘迫综合征(NRDS)新生儿。随机分为观察组40例和对照组38例，分别给予芬太尼静脉滴注镇痛治疗[静脉滴注芬太尼注射液，加入5%葡萄糖溶液以2μg/(kg·h)量持续滴注，1 d后减为1μg/(kg·h)。前后持续2 d]和常规安慰剂治疗（100.0 mg剂量维生素B6加入5%葡萄糖溶液）。采用新生儿疼痛评分量表(N-PASS)对两组患儿分别于插管后当时、2、6、12 h和24 h进行疼痛评分，并记录呼吸机参数如吸气峰压（PIP）。结果使用芬太尼治疗的观察组自第2小时开始5个时间N-PASS评分分别为（4.5±1.1）分（、3.8±1.4）分（、3.2±1.4）分（、2.3±1.3）分，均低于对照组（P＜0.01或0.05）。观察组自第6小时开始，12 h和24 h3个时间点的心率分别为（131±17）次/min（、129±17）次/min（、124±13）次/min，较对照组均明显下降，差异有统计学意义（P＜0.01）。插管前12 h，两组PIP值均呈下降趋势，但差异无统计学意义，但自12 h开始，观察组PIP值较对照组逐渐升高（P＜0.01）。结论芬太尼对机械通气下新生儿镇痛改善有确切效果，可减缓疼痛引起的心率加快、情绪烦躁等不良影响，可展开进一步研究与临床实践。%Objective To discuss analgesic effect of fentanyl in mechanical ventilation in newborn. Methods From 2010 March to 2011 February in the neonatal ICU of the hospital 78 cases of 24 h was born by chest X-ray examination confirmed the diagnosis of respiratory distress syndrome (NRDS) in neonates. Were randomly divided into the observation group 40 cases and control group 38 cases, were given fentanyl infusion analgesia therapy (intravenous injection of fentanyl injection, 5%glucose solution by 2μg/(kg•h) volume infusion, 1 D decreased to 1μg/(kg•h). Before and after 2 d) and conventional placebo (100.0 mg dose of vitamin B 6 in 5%glucose solution). The neonatal pain rating scale (N-PASS) of two groups of patients were at 2, 6, after intubation, 12 h and 24 h pain scores were recorded, and ventilator parameters such as peak inspiratory pressure (PIP). Results The observation group use fentanyl treatment from second hours to 5 hours N-PASS scores were (4.5±1.1)%, (3.8±1.4)%, (3.2±1.4)%, (2.3±1.3), were lower than the control group (P<0.01 or 0.05). Observation group since sixth hours, 12 h and 24 h 3 time points of heart rate was (131±17)/min, (129±17)/min, (124±13)/min, decreased significantly compared with the control group, the difference was statistically significant (P<0.01). 12 h in two groups before intubation, PIP value decreased, but the difference was not statistically significant, but since the start of 12 h, PIP in observation group compared with the control group increased gradually (P<0.01). Conclusion Fentanyl has an exact effect on mechanical ventilation in neonatal pain improvement, can ease the pain caused by increased heart rate, emotional irritability and other adverse effects, but further research and clinical practice.
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