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目的观察小剂量吗啡对重症手足口病机械通气患儿镇静的有效性和安全性。方法 2010年1月—2014年12月期间,收住儿科重症监护病房(PICU)且需行机械通气的重症手足口病患儿78例,随机均分为对照组和观察组。对照组患儿静脉给予咪达唑仑0.1 mg/kg后,以0.05~0.15 mg/(kg·h)维持;给予舒芬太尼0.1μg/kg后,以0.03~0.06μg/(kg·h)维持;观察组患儿静脉给予吗啡40μg/kg后,以10~30μg/(kg·h)静脉维持。首要观察指标是Ramsay评分、吸气峰压(PIP)、氧合指数、肌酸激酶(CK-MB)、机械通气时间。次要观察指标为血气、PICU入住时间、住院费用等。结果 2组患儿均达到完善的镇静状态。机械通气后,PIP逐渐降至正常,但在插管后12 h(T_(12h))和插管后1 d(D_1),观察组PIP明显低于对照组(P=0.04;P=0.03);患儿的氧合指数也逐渐改善,观察组在T_(12h)、D_1时间点明显优于对照组(P=0.01;P=0.04);肌酸激酶也在机械通气后逐渐降低,但对照组患儿肌酸激酶在T_(12h)、D_1和拔管前均明显高于观察组(P=0.05;P=0.05;P=0.03)。此外,观察组机械通气时间较对照组明显减少(P=0.02);观察组PICU入住时间明显短于对照组(P=0.02),住院费用也明显减少(P<0.01)。结论机械通气期间给予小剂量吗啡和咪达唑仑联合舒芬太尼,均能使重症手足口病患儿达到满意的镇静程度。小剂量吗啡能较快地改善患儿的缺血缺氧症状和心肺功能,明显减少患儿机械通气时间、PICU的入住时间及住院费用。
Objective To observe the effectiveness and safety of low-dose morphine in sedation of severe hand-foot-mouth disease in children with mechanical ventilation. Methods From January 2010 to December 2014, 78 children with severe hand-foot-mouth disease admitted to pediatric intensive care unit (PICU) undergoing mechanical ventilation were randomly divided into control group and observation group. The control group received intravenous midazolam 0.1 mg / kg and maintained at 0.05-0.15 mg / (kg · h). After administration of 0.1 μg / kg sufentanil, 0.03-0.06 μg / (kg · h) ). The observation group was intravenously administered with morphine 40μg / kg intravenously at 10 ~ 30μg / (kg · h). Primary observational indicators were Ramsay score, peak inspiratory pressure (PIP), oxygenation index, creatine kinase (CK-MB), duration of mechanical ventilation. Secondary observation indicators for blood gas, PICU admission time, hospitalization fees. Results 2 groups of children have achieved perfect sedation. PIP gradually decreased to normal after mechanical ventilation, but the PIP in observation group was significantly lower than that in control group at 12 h (T 12h) and 1 d after intubation (P = 0.04; P = 0.03) ; Oxygenation index in children also gradually improved, the observation group at T (12h), D_1 time point was significantly better than the control group (P = 0.01; P = 0.04); creatine kinase decreased gradually after mechanical ventilation, but the control Creatine kinase in group B was significantly higher than that in observation group at T 12h, D 1 and extubation (P = 0.05; P = 0.05; P = 0.03). In addition, the duration of mechanical ventilation in the observation group was significantly lower than that in the control group (P = 0.02). The admission time of the PICU in the observation group was significantly shorter than that in the control group (P = 0.02) and the hospitalization expense was also significantly reduced (P <0.01). Conclusions A small dose of morphine and midazolam combined with sufentanil during mechanical ventilation can achieve satisfactory sedation in children with severe hand-foot-mouth disease. Small doses of morphine can quickly improve children with hypoxic-ischemic symptoms and cardiopulmonary function, significantly reducing the mechanical ventilation time, PICU check-in time and hospitalization costs.