芬太尼静脉镇痛在新生儿呼吸机辅助呼吸中的有效性和安全性分析

摘要

目的：评估芬太尼静脉镇痛在新生儿呼吸机辅助呼吸中的有效性和安全性。方法选取2012年11月至2015年1月广东医学院附属南山医院新生儿科收治的因患新生儿呼吸窘迫综合征行气管插管呼吸机辅助呼吸的新生儿42例，采用随机数字法分为试验组和对照组，各21例。试验组于气管插管呼吸机辅助呼吸后静脉输入芬太尼镇静治疗，使用2μg／（kg· h），维持48 h 后，改为1μg／（ kg· h），维持72 h停药。对照组于气管插管呼吸机辅助呼吸后维持静脉输入葡萄糖液5％葡萄糖12 mL 0.5 mL／h维持72 h。记录两组患儿用药前后早产儿疼痛评分简表（ PIPP）评分、呼吸机参数以及用药后治疗时间指标变化和并发症发生情况。结果试验组24、48、72 h PIPP 评分较0 h呈下降趋势，而对照组PIPP评分未随时间的推移有下降趋势。试验组及对照组24、48、72 h吸氧浓度均较0 h有不同程度的下降，但试验组下降速度更慢；试验组及对照组24、48、72 h平均气道压、呼吸频率均较0h有不同程度的下调，但试验组下降速度更慢，两组在组间、时点间及组间·时点间交互作用差异有统计学意义（ P＜0.05）。两组患儿上机时间、吸氧时间、住院时间、恢复至出生体质量时间、达80 mL／（kg· d）肠道喂养时间比较差异无统计学意义（P＞0.05）。试验组动脉导管未闭发生率显著低于对照组[35.0％（7／20）比70.0％（14／20）]，尿潴留发生率高于对照组[90.0％（18／20）比0％（0／0）]，差异有统计学意义（P ＜0.05）。结论静脉注射芬太尼对需要呼吸机辅助呼吸的新生儿有较好的镇痛作用，但会增高呼吸机参数，未明显增加并发症的发生率。芬太尼作为新生儿呼吸机辅助呼吸的镇痛治疗的安全性值得肯定。%Objective To investigate the efficiency and the safety of fentanyl on neonates on mechanical ventilation for neonatal respiratory distress syndrome ( NRDS ) .Methods This study enrolled 42 preterm infants with NRDS who received mechanical ventilation with intubation in NICU of Nanshan Hospital ,Guang-dong Medical College from Nov.2012 to Jan.2015.The neonates were divided into a trial group and a control group according to random number method,21 cases each.The trial group was given fentanyl after mechanical ventilation with the initial dose of 2 μg/(kg· h),maintained for 48 h,then reduced to 1 μg/(kg· h), withdrawal at 72 h.The control group was given glucose(5% glucose 12 mL,0.5 mL/h withdrawal at 72 h) after mechanical ventilation.The neonatal pain,preterm infant pain profile ( PIPP) were used to assess the infants behavior before or after the teatment.The PIPP scores,ventilator parameters and complications were recorded.Results A gradual downward trend was observed in 24,48,72 h PIPP than 0 h in the trial group, while there was no down trend observed in the control group.The fraction of inspired oxygen( FiO2 ) at 24, 48,72 h of both groups decreased from 0 h,and the trial group decreased slower;The 24,48,72 h mean air-way pressure( MAP) and respiratory rate of both groups were down regulated than the 0 h MAP and respira-tory rate,and the trial group decreased slower.The differences between the groups,different time points and the interaction of groups· time points were statistically significant(P<0.05).There were no differences in duration of mechanical ventilation,days to reach 80 mL/(kg· d),time to recover to birth weight,length of hospital stay between the two groups during the study(P>0.05).The incidence of patent ductus arteriosus (PDA) of the trial group was significantly lower than the control group[35.0%(7/20) vs 70.0%(14/20), P<0.05].The incidence of uroschesis was higher than the control group[90.0%(18/20) vs 0%(0/0), P<0.05].Conclusion Intravenous fentanyl for neonates who was on mechanical ventilation for NRDS has good analgesic effect,which increases breathing machine parameters without obvious complication increase . The safety of fentanyl as an analgesic in the treatment of neonatal on mechanical ventilation for NRDS is affirmative.