咪哒唑仑在新生儿胎粪吸入综合征机械通气中的镇静止痉效果观察_临床医学论文.docVIP

咪哒唑仑在新生儿胎粪吸入综合征机械通气中的镇静止痉效果观察_临床医学论文 咪哒唑仑在新生儿胎粪吸入综合征机械通气中的镇静止痉效果观察_临床医学论文 【摘要】 目的：对咪哒唑仑和地西泮在新生儿胎粪吸入综合征（MAS）机械通气中的镇静止痉效果进行临床比效。方法：回顾性分析临床上存在人机对抗、抽搐以致呼吸机参数下调困难、血氧饱和度不稳定而需用镇静药治疗的40例MAS机械辅助通气患儿，根据镇静方法的不同分为治疗组和对照组各20例。两组患儿都使用苯巴比妥饱和量，治疗组加用咪哒唑仑，首剂0.1～0.2 mg/(kg·次)，后改为0.05～0.15 mg/（kg·h）维持并逐渐减量至脱机，对照组根据病情反复使用地西泮0.1～0.3 mg/(kg·次)，比较两组的镇静止痉效果及安全性。结果：两组患儿上呼吸机辅助治疗24 h、48 h的呼吸机参数及3 d后心肌酶谱结果比较差异有统计学意义（P均lt;0.01），治疗组优于对照组。结论：苯巴比妥联合咪哒唑仑对MAS呼吸机辅助通气下的人机对抗、抽搐的镇静止痉效果优于苯巴比妥联合地西泮，起效快，使用安全有效，值得推广。 【关键词】 咪哒唑仑；地西泮；新生儿；胎粪吸入综合征；机械通气 ［Abstract］ Objective:To investigate the clinical comparison between midazolam and diazepam in adjunctive ventilation for neonates with meconium aspiration syndrome (MAS). Methods:Retrospective analysis was performed on 40 infants with MAS who had mechanical ventilation as an adjunctive treatment and then had manmachine conflict, spasms leading to difficulties in turning down the parameters of the breathing machine, unstable oxygen saturation, which made the sedative treatment needed. These neonates were divided into the treatment group and the control group. Both groups used the phenobarbital up to its saturation with the treatment group having midazolam in addition, first dosage of 0.1～0.2 mg/kg, and then cut down to 0.05ng 0.1～0.3 mg/kg of diazepam repeatedly and continuously according to the condition. The curative effects and security of midazolam and diazepam were compared then. Results:The difference of 24 hour, 48 hour machine parameters and the myocardial zymograms 3 days later between the two groups were significant statistically (0.01). Conclusions:The combined treatment of phenobarbital and midazolam for symptoms caused by mechanical ventilation in neonates with MAS is more effective and worth promoting. ［Key words］ Midazolam; Diazepam; Neonate; Meconium aspiration syndrome; Mechanical ventilation 　 新生儿胎粪吸入综合征（Meconium aspiration syndrome,MAS）指新生儿在分娩前、分娩过程中或分娩后的瞬间吸入胎粪阻塞呼吸道，出现呼吸系统的症状，多见于足月儿，是新生儿致死的一种常见疾病，发病率占活产新生儿的1.2%～1.6%，如果不采取积极的治疗措施则病死率较高［1］。国内报告