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目的:观察咪达唑仑联合芬太尼对危重症肠道病毒71型(EV71)感染患儿血浆儿茶酚胺水平的影响。方法:选取2012年5月至2014年5月我院PICU收治的危重症EV71感染患儿10例作为观察组,另选同期在我院PICU住院治疗的急性呼吸衰竭患儿10例作为对照组。两组均予咪达唑仑[负荷量0.1 mg/kg,维持量1.0~5.0μg/(kg·min)]和芬太尼[0.5~2.0μg/(kg·h)]镇静治疗。分别于用药前和用药后12 h采集患儿血液标本,采用酶联免疫吸附法(ELISA)测定血浆多巴胺(DA)、肾上腺素(E)、去甲肾上腺素(NE)水平,并比较观察组用药前后的血浆儿茶酚胺(CA)水平。结果:观察组用药前DA(8.84±1.53)ng/m L、E(1.29±0.35)ng/m L、NE(10.19±2.48)ng/m L,用药后DA(8.54±0.52)ng/m L、E(1.15±0.10)ng/m L、NE(8.48±0.44)ng/m L;对照组用药前DA(1.43±0.34)ng/m L、E(0.59±0.15)ng/m L、NE(5.35±1.98)ng/m L。观察组用药前血浆CA(DA、E、NE)水平均高于对照组(P均<0.01),用药后血浆DA、E水平与用药前比较差异无统计学意义(P>0.05),而血浆NE水平较用药前降低(P<0.05)。结论:危重症EV71感染患儿血浆CA水平有明显升高,有助于早期发现危重症病例;咪达唑仑联合芬太尼可降低危重症EV71感染患儿血浆NE水平,而对DA、E影响不大。
Objective: To observe the effect of midazolam combined with fentanyl on plasma catecholamine levels in children with critically ill enterovirus 71 (EV71) infection. Methods: From May 2012 to May 2014, 10 children with EV71 infection were selected as the observation group and 10 children with acute respiratory failure who were hospitalized in our hospital during the same period as the control group. Both groups were sedated with midazolam [loading 0.1 mg / kg, maintenance 1.0 to 5.0 μg / (kg · min)] and fentanyl [0.5-2.0 μg / (kg · h)]. Blood samples of children were collected before treatment and 12 h after treatment respectively. Plasma dopamine (DA), epinephrine (E) and norepinephrine (NE) were measured by enzyme-linked immunosorbent assay (ELISA) Plasma catecholamine (CA) levels before and after treatment. Results: Before treatment, DA (8.84 ± 1.53) ng / m L, E (1.29 ± 0.35) ng / m L and NE (10.19 ± 2.48) ng / (1.43 ± 0.34) ng / m L, E (0.59 ± 0.15) ng / m L, E (1.15 ± 0.10) ng / m L and NE (8.48 ± 0.44) ng / NE (5.35 ± 1.98) ng / m L. The levels of plasma CA (DA, E, NE) in the observation group before treatment were significantly higher than those in the control group (all P <0.01). There was no significant difference in the levels of plasma DA and E before treatment (P> 0.05) NE level was lower than before treatment (P <0.05). CONCLUSION: Serum CA levels in critically ill children with EV71 infection are significantly increased, which may be helpful to early detection of critically ill patients. Midazolam combined with fentanyl can reduce the levels of plasma NE in children with critically ill EV71 infection, Has little effect.