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目的:探讨阿片类药物对行机械通气新生儿疼痛程度、生命体征及远期神经功能发育的影响。方法:选取我院2010年1月至2014年11月收治的行机械通气新生儿135例,按照随机区组法分为对照组68例和试验组67例,排除死亡和失访病例,实际纳入研究128例,对照组和试验组各64例。两组患儿气管插管后分别给予安慰剂和芬太尼静脉给药,比较两组患儿用药前后新生儿疼痛(PIPP)评分、生命体征指标水平,随访智力发育指数(MDI)和精神运动发育指数(PDI)。结果:试验组患儿用药后30 min、1 h及2 h PIPP评分均显著低于对照组,差异有统计学意义(P<0.05);两组患儿用药前后平均动脉压和经皮血氧饱和度水平比较差异无统计学意义(P>0.05);试验组患儿用药后30 min、1 h及2 h呼吸频率和心率水平均显著低于对照组,差异有统计学意义(P<0.05);两组患儿随访不同月龄MDI和PDI水平比较差异无统计学意义(P>0.05)。结论:阿片类药物可有效缓解行机械通气新生儿气管插管疼痛,降低心率和呼吸频率,且对远期神经功能发育无不良影响。
Objective: To investigate the effects of opioids on the degree of pain, vital signs and long-term neurological development in neonates with mechanical ventilation. Methods: A total of 135 neonates with mechanical ventilation admitted from January 2010 to November 2014 in our hospital were divided into control group (n = 68) and experimental group (n = 67) according to randomized block method. Cases of death and lost follow-up were excluded, Study of 128 cases, the control group and the experimental group of 64 cases. The two groups of children were given intratracheal placebo and fentanyl intravenously after intubation. The PIPP score, vital signs, follow-up mental development index (MDI) and psychomotor Developmental Index (PDI). Results: The PIPP scores at 30 min, 1 h and 2 h after treatment in the experimental group were significantly lower than those in the control group (P <0.05). Mean arterial pressure and percutaneous oxygenation (P <0.05). The respiratory rate and heart rate at 30 min, 1 h and 2 h after treatment in the experimental group were significantly lower than those in the control group (P <0.05), and the difference was not statistically significant ). There was no significant difference in MDI and PDI between two groups at different months of follow-up (P> 0.05). Conclusion: Opioids can effectively relieve tracheal intubation pain, reduce heart rate and respiratory rate in neonates with mechanical ventilation, and have no adverse effect on long-term neurological development.