两种镇静镇痛策略辅助治疗重症手足口病机械通气患儿的效果

目的 探讨两种镇静镇痛方案(咪达唑仑、咪达唑仑联合芬太尼)辅助治疗重症手足口病机械通气患儿 的效果。方法 选取本院诊治的重症手足口病患儿190例,均行机械通气治疗,根据治疗方案分为两组,95例患儿应 用咪达唑仑镇静镇痛为M 组,95例患儿应用咪达唑仑联合芬太尼镇静镇痛为M+F组,比较两组患儿的治疗效果。 结果 镇静后,两组患儿镇静程度(Ramsay)评分均在合理的镇静范围。M+F组患儿镇静后2、4、6、8、10、12小时 Ramsay评分更接近理想的镇静终点,与M 组比较差异有统计学意义(P <0.01)。两组患儿PAED 评分均显著降 低。随着镇静时间的延长,麻醉苏醒期躁动量化评分表(PAED)评分降低幅度越明显。M+F组患儿镇静后2、4、6、 8、10、12小时PAED评分明显低于M 组(P <0.01)。M+F组患儿自主呼吸时间、睁眼时间、准确完成指令时间、拔 管时间、定向力恢复时间均明显早于M 组(P <0.01)。M+F组患儿机械通气时间、ICU 住院时间、总住院时间均明 显少于M 组(P <0.01)。结论 咪达唑仑联合芬太尼镇静镇痛可明显缓解患儿的疼痛,发挥良好的镇静作用,减轻 躁动,还能缩短苏醒时间和治疗时间,效果显著,值得临床推广使用。

Effect of two analgesic and sedation strategies in treating severe hand foot mouth children with mechanical ventilation

Objective To investigate the effect of two analgesic and sedation strategies (midazolam and midazolam combined with fentanyl) in treating severe hand foot mouth children with mechanical ventilation. Methods A total of 190 children with severe hand foot mouth disease treating with mechanical ventilation were selected. According to treatment program， all patients were divided into two groups， including 95 patients with midazolam as M group and 95 patients with midazolam combined with fentanyl as M+F group. Therapeutic effect was compared between both groups. Results After treatment， ramsay scores were within a reasonable range in both groups. After sedation of 2 h， 4 h， 6 h， 8 h， 10 h and 12 h， Ramsay score was closer to ideal sedation end point in M+F group than in M group (P<0.01). After sedation， PAED score was significantly decreased in both groups. As sedation time prolonged， PAED score decreased more significantly. After sedation of 2 h， 4 h， 6 h， 8 h，10 h and 12 h， PAED score was significantly lower in M+F group than in M group (P<0.01). Spontaneous breathing time， eye opening time， accurately complete instruction time， extubation time and orientation recovery time were significantly earlier in M+F group than in M group (P<0.01). Mechanical ventilation time， ICU hospitalization time and total hospitalization time were significantly decreased in M+F group than in M group (P<0.01). Conclusion Midazolam combined with fentanyl can obviously relieve pain， reduce agitation， shorten recovery time and treatment time and it is worthy of clinical use.