機械換気による早産児の脳機能に対するフェンタニルの保護作用【JST・京大機械翻訳】

Abstract

Objective To discuss the short-and long-term outcome of neuro-function with continuous Fentanyl infusion in ventilated prematurity. Methods Fifty-three ventilated preterm infants in the NICU of Nanjing Children's Hospital Affiliated to Nanjing Medical University from November 2012 to November 2014 were randomized into 2 groups of which 26 patients were in control group without receiving Fentanyl infusion, and 27 patients in study group.Study group received Fentanyl infusion at 1 μg /(kg·h) immediately after the intubation, and Fentanyl was reduced to half dose when ventilation settings were as below: mean airway pressure (MAP)<7 cmH2O(1 cmH2O=0.098 kPa), fraction of inspired oxygen (FiO2)<0.25, breathing rate<25 beats/min (synchronized intermittent mandatory ventilation), or MAP<10 cmH2O(high frequency oscillation). If patients were stable Fentanyl was weaned off in 30 minutes then the baby was extubated.Control group received 50 g/L glucose infusion at a same rate.Same stan-dard care was provided to all patients.(1) Ventilation settings including MAP, FiO2, arterial oxygen saturation, partial pressure of carbon dioxide in artery, partial pressure of oxygen in artery, respiratory rate, mean blood pressure, heart rate, duration of ventilation, side effects before and after intubation(2, 12, 24, 48 h) were compared. (2)Behavior responses to pain were assessed and compared by using premature infant pain profile (PIPP) and COMFORT scores.(3) Amplitude integrated electro-encephalogram (aEEG)in 37 weeks of corrected gestational age and neonatal behavioral neurological assessment (NBNA) scores in 40 weeks of corrected gestational age were compared. Results (1) There was no significant difference in ventilation settings, mean blood pressure, duration of ventilation, and side effects.Heart rates in control group were lower than those in study group in 12, 24 and 48 hours after intubation with significant difference(t=6.36, 7.01, 6.28, all P<0.05); respiratory rates in control group were lower than those in study group in 24 and 48 hours after intubation with significant difference(t=12.48, 10.34, all P<0.05). (2)Two hours after intubation PIPP and COMFORT scores in control group were lower than those in study group with significant difference (all P<0.05), especially in 12 hours after intubation(P<0.01). (3) NBNA and aEEG scores in control group were higher than those in study group (t=4.85, 3.27, all P<0.05). Conclusions Fentanyl infusion has potential protection for developing brain of ventilated prematurity by relieving pain during mechanic ventilation period, and improving NBNA scores and aEEG. Key words: Fentanyl infusion; Infant, preterm; Mechanical ventilation; Neuro-function