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目的观察咪达唑仑联合舒芬太尼在重症医学科中治疗小儿多发伤的镇静、镇痛作用。方法 24例重症患儿均给予静脉注射负荷量咪达唑仑0.15~0.30 mg/kg,再给予咪达唑仑0.05~0.10 mg/(kg·h)、舒芬太尼0.3~1.5μg/(kg·h)微泵注射维持。根据患儿情况个体化调整入量,维持Ramsay镇静评分3~4分。通过监测患者心率、呼吸、平均动脉压、动脉血气进行治疗前后对比评估;对治愈患儿出院后1,2,4周的头痛、嗜睡、共济失调的不良反应进行随访观察。结果在负荷剂量及维持量下所有患儿均能达到镇痛、镇静的效果,Ramsay评分在3~4分。患儿用药5,30,60 min后心率、呼吸、平均动脉压、动脉血气均较用药前明显改善(P<0.01);4周内不良反应基本消失。结论咪达唑仑联合舒芬太尼持续泵注能显著提高多发伤重症患儿的镇痛、镇静效果。
Objective To observe the sedative and analgesic effects of midazolam combined with sufentanil in the treatment of pediatric multiple trauma in critical care. Methods All 24 severely ill infants were given intravenous midazolam 0.15-0.30 mg / kg, midazolam 0.05-0.10 mg / (kg · h), sufentanil 0.3-1.5 μg / ( kg · h) micro-pump injection to maintain. According to the circumstances of individual children adjust the amount of maintenance of Ramsay sedation score 3 to 4 points. By monitoring the patient’s heart rate, respiration, mean arterial pressure, arterial blood gas before and after treatment to evaluate the comparison; to cure 1,2,4 weeks after discharge in children with headache, lethargy, ataxia adverse reactions were followed up. Results All patients under loading dose and maintenance dose achieved analgesic and sedative effects with a Ramsay score of 3 to 4. Heart rate, respiration, mean arterial pressure and arterial blood gas were significantly improved in children with drug administration at 5, 30 and 60 min after treatment (P <0.01). Adverse reactions disappeared in 4 weeks. Conclusions Midazolam combined with sufentanil can significantly improve the analgesic and sedative effects in children with multiple traumatic injuries.