芬太尼对早产儿机械通气镇痛、镇静中血清皮质醇、儿茶酚胺等影响的研究

情[7]㊂试验组的各项心功能指标均优于对照组,差异均有统计学意义(P <0.05);不良反应发生率(7.14%)略低于对照组(11.90%),差异无统计学意义(P >0.05)㊂原因如下:厄贝沙坦可抑制ANGⅡ,对心功能有较佳的保护作用;比索洛尔可避免因β受体有效介导导致心律失常,其可降低交感神经的兴奋性㊂而两种药物均经口服治疗,机体内无药物潴留,用药安全,与韩璐等研究结果[8]基本一致㊂可见,以上联合疗法可有效改善CHF 合并PVC 患者的血清BNP 水平与心功能指标,利于症状缓解,具有较高的治疗安全性㊂4　参考文献

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[3]　Penglong.Wu,Xun.Yuan,Faqian.Li,et al.Myocardial Up⁃regulation of Cathepsin D by Ischemic Heart Disease Promotes Au⁃tophagic Flux and Protects Against Cardiac Remodeling and Heart

Failure[J].Circulation:Heart Failure,2017,(7):e004044.[4]　阮立培.比索洛尔联合厄贝沙坦治疗慢性心力衰竭的临床疗效[J].临床合理用药杂志,2017,10(12):54.

[5]　陈东运,王芸芝,孙巧丽.比索洛尔联合厄贝沙坦用于慢性心力衰竭治疗的可行性研究[J].中国现代药物应用,2016,10(20):103.

[6]　Fermann G J,Levy P D,Pang P,et al.Design and Rationale of a Randomized Trial of a Care Transition Strategy in Patients With Acute Heart Failure Discharged From the Emergency Depart⁃ment:GUIDED-HF (Get With the Guidelines in Emergency De⁃partment Patients With Heart Failure)[J].Circulation Heart Fail⁃ure,2017,10(2):e003581.

[7]　潘晓武.厄贝沙坦联合比索洛尔治疗90例慢性心力衰竭疗效观察[J].医学信息,2015,(49):413.

[8]　韩　璐,贾岩龙.比索洛尔与厄贝沙坦氢氯噻嗪治疗原发性高血压的疗效对比研究[J].大家健康(下旬版),2015,

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[收稿日期:2018-07-02　编校:王丽娜]

芬太尼对早产儿机械通气镇痛㊁镇静中血清皮质醇㊁儿茶酚胺等影响的研究

梁　剑,孟　琼,彭爱玲　(广东省第二人民医院,广东　广州　510317)

[摘　要]　目的:探讨芬太尼对机械通气早产儿血清皮质醇(cortisol ,COR )和血浆肾上腺素(adrenaline ,ADR )㊁去甲肾上腺素(norepinephrine ,NAD )㊁多巴胺(dopamine ,DOP )水平的影响㊂方法:选取2018年1月~12月的新生儿科胎龄28~36周㊁出生体重1000~2499g 且需要机械通气的早产儿60例为研究对象,采用单纯随机抽样的方法分为观察组(应用芬太尼)30例和对照组30例㊂两组患儿分别于机械通气初及机械通气24h 测定血COR ㊁ADR ㊁NAD 和DOP 水平,并进行比较分析㊂结果:观察组和对照组机械通气初各评分及血指标差异均无统计学意义(P >0.05),观察组应用芬太尼后24h 血COR ㊁ADR ㊁NAD 和DOP 低于对照组COR :(162.4±25.4)nmol /L 比(321.8±71.4)nmol /L ,ADR :(32.9±5.9)ng /L 比(46.2±5.2)ng /L ,NAD :(144.3±16.3)ng /L 比(231.8±25.2)ng /L ,DOP :(47.6±7.3)ng /L 比(84.3±10.4)ng /L ,差异均有统计学意义(P <0.05)㊂结论:早产儿机械通气时应用芬太尼镇痛和镇静能降低血COR ㊁ADR ㊁NAD

和DOP 水平,减轻应激反应㊂

[关键词]　早产儿;机械通气;芬太尼;儿茶酚胺;血清皮质醇

基金项目:广东省医学科学技术研究基金项目[项目编号:B2017047]

The effects of fentanyl on serum cortisol and catecholamine in preterm infants with mechanical ventila⁃tion LIANG Jian ,MENG Qiong ,PENG Ai -ling (The Second People′s Hospital of Guangdong Praince ,Guangzhou 510317,

China )

Abstract :Objective To study the effect of fentanyl on serum concentrations of cortisol (COR),adrenaline (ADR),norepi⁃nephrine (NAD)and dopamine (DOP)in premature infants requiring mechanical ventilation(MV).Method From January to December,2018,60cases of premature infants(gestational age:28~36weeks ang body weight:1000g ~2499g)admitted to neonatal department of our hospital and received mechanical ventilation were prospectively studied.The participants were random⁃ly assigned into divided into observation group(application of fentanyl)30cases and control group 30cases,and the serum con⁃

centrations of COR,ADR,NAD and DOP were measured at the beginning of MV and 24h after MV /fentanyl.The scores and