芬太尼在机械通气新生儿镇痛中的临床应用分析

Analgesic effect of fentanyl in neonates during mechanical ventilation

摘要:

目的 探讨芬太尼对机械通气新生儿的镇痛效果及安全性。方法 将2010 年12 月至2011 年2月接受机械通气的30 例新生儿随机分为芬太尼组和对照组,每组均为15 例,两组除常规治疗外,芬太尼组加用芬太尼镇痛治疗。记录两组患儿在用药前及用药后30 min、2 h、4 h 的心率、呼吸频率、血压的变化及PIPP评分。患儿出院后进行随访,分别在3、6、9 和12 月龄时用CDCC 婴幼儿智能发育量表测定两组患儿智力发育指数(MDI)和精神运动发育指数(PDI)。结果 芬太尼组使用芬太尼后,其呼吸频率和心率均较对照组下降(P<0.05), PIPP 评分较对照组明显降低(P<0.05)。随访结果显示芬太尼组患儿在3、6、9 和12 月龄时MDI 和PDI 与对照组比较,差异均无统计学意义(P>0.05)。结论 芬太尼能有效缓解机械通气患儿的疼痛反应,且对患儿远期神经发育情况无影响。

Abstract:

Objective To study the analgesic effect and safety of fentanyl in neonates receiving mechanical ventilation. Methods Thirty neonates receiving mechanical ventilation between December 2010 and February 2011 were randomized into drug intervention group and control group (n=15 each). In addition to the conventional treatment for both groups, the drug intervention group received fentanyl as the analgesic treatment. Heart rate, respiratory rate, blood pressure changes, and premature infant pain profile (PIPP) score before treatment and at 30 minutes, 2 hours, and 4 hours after treatment were recorded in both groups. Follow-up visits were performed for these infants after discharge, and the CDCC intellectual development scale for infants was applied to measure mental development index (MDI) and psychomotor development index (PDI) at 3, 6, 9, and 12 months of age. Results The respiratory rate and heart rate decreased in the drug intervention group after fentanyl treatment compared with the control group (P<0.05), and the PIPP scores in the drug intervention group was significantly lower than in the control group (P<0.05). The results of follow-up visits showed no significant differences in MDI and PDI at 3, 6, 9 and 12 months of age between the drug intervention and control groups (P>0.05). Conclusions Fentanyl can relieve the pain response in neonates receiving mechanical ventilation, with no long-term adverse effects on neurodevelopment.