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早产儿气管插管有创机械通气可引起患儿不适,但是否导致疼痛仍存有争议.已发表的荟萃分析显示,早产儿机械通气期间应用麻醉镇痛药并未减轻患儿疼痛.因此,不推荐对新生儿重症监护病房(NICU)机械通气早产儿常规应用麻醉镇痛药和镇静剂.假设目前加拿大NICU早产儿机械通气过程中麻醉镇痛药和镇静剂的使用呈下降趋势.该研究回顾性分析了2004~2009年间出生胎龄 24 h的早产儿接受镇静剂和麻醉镇痛药使用的趋势.入院时处于濒死状态、先天畸形、需要外科手术(除外眼科激光手术)、坏死性小肠结肠炎、胸腔置管引流或孕母有麻醉药品滥用史的早产儿不纳入该研究.根据早产儿是否接受麻醉镇痛药(如吗啡、芬太尼、美沙酮、舒芬太尼、杜冷丁、阿芬太尼和可待因等)或镇静剂(如水合氯醛、咪达唑仑、劳拉西泮、苯巴比妥、戊巴比妥、氯胺酮和丙泊酚)以及早产儿胎龄(胎龄24 consecutive hours during MV. Trends of narcotics and sedatives were assessed using the Cochrane-Armitage Trend test separately for PTI born at <29 and 29-34 weeks of GA. Results Among 5 638 study subjects, 2 169 (38.5%) received narcotics and 897 (15.9%) received sedatives. The most common narcotics were morphine (62.2%) and fentanyl (63.8%) and sedatives were phenobarbital (44.9%) and chloral hydrate (44.2%). A significant decreasing trend (P<0.01) in the use of any sedatives during MV was observed in PTI <29 and 29-34 weeks of GA. However, the use of any narcotics during MV increased significantly (P=0.03) among PTI <29 weeks of GA, and no change in trend was detected for PTI born at 29-34 weeks of GA. Conclusions The use of sedatives during MV in PTI born at <35 weeks of GA was positively affected, however the narcotics use during MV remained constant for PTI born at 29-34 weeks, and increased in extremely low GA group (less than 29 weeks) suggesting evidence based practice change was not observed during the study period.