Application effect of sedation and analgesia with Fentanyl and Midazolam in modified percutaneous tracheostomy for severe patients in neurosurgery
DU Xiuyu1 ZHAI Xiaodong1 LIU Zhi1 LI Yuanli2 YANG Jing1 SUN Zhiqiang1 YANG Xiaohong1 GAO Fei3
1.Department of Neurosurgery (Ward 15), the First Affiliated Hospital of Hebei North University, Hebei Province, Zhangjiakou 075000, China;
2.Department of Intensive Care Unit, the First Affiliated Hospital of Hebei North University, Hebei Province, Zhangjiakou 075000, China;
3.Department of Emergency Intensive Care Unit, the First Affiliated Hospital of Hebei North University, Hebei Province, Zhangjiakou 075000, China
Abstract：Objective To evaluate the application effect of sedation and analgesia with Fentanyl and Midazolam in modified percutaneous tracheostomy for severe patients in neurosurgery. Methods Clinical data of 71 patients whom underwent modified percutaneous tracheostomy in the First Affiliated Hospital of Hebei North University were collected from June 2018 to September 2019. They were divided into two groups according to the drugs for sedation and analgesia randomly, Fentanyl and Midazolam were used in the observation group (n = 36) and Diazepam or lytic cocktail were used in the control group (n = 35). The operation time, blood oxygen saturation, tracheal stimulus response, intraoperative and postoperative bleeding volume were compared between the two groups. Results There was no statistically significance in operation time of two groups (P > 0.05). There were no significant differences in intraoperative and postoperative bleeding volume of the two groups (P > 0.05). Tracheal stimulus response of observation group was weaker than control group, the difference was statistically significant (P < 0.01). Blood oxygen saturation in observation group was higher than that in control group, the difference was statistically significant (P < 0.01). No operation related death or pneumothorax case in two groups. Conclusion Sedative and analgesic therapy with Fentanyl and Midazolam can reduce tracheal stimulus response and maintain a stable blood oxygen saturation in modified percutaneous tracheostomy effectively, and it is a safer procedure.
杜秀玉1 翟晓东1 刘志1 李媛莉2 杨静1 孙志强1 杨晓洪1 高飞3. 芬太尼联合咪达唑仑镇痛镇静在神经外科重症患者改良经皮气管切开中的应用效果[J]. 中国医药导报, 2020, 17(16): 109-111,138.
DU Xiuyu1 ZHAI Xiaodong1 LIU Zhi1 LI Yuanli2 YANG Jing1 SUN Zhiqiang1 YANG Xiaohong1 GAO Fei3. Application effect of sedation and analgesia with Fentanyl and Midazolam in modified percutaneous tracheostomy for severe patients in neurosurgery. 中国医药导报, 2020, 17(16): 109-111,138.
[1] 杜秀玉，殷尚炯，刘洪泉，等.改良微创经皮气管切开术在神经外科肥胖重症患者中的应用[J].临床耳鼻咽喉头颈外科杂志，2015，29（14）：1302-1303.
[2] 杜秀玉，王志明，赵会娟，等.改良微创经皮气管切开术在基于国人BMI指数的不同体型脑损伤人群中的实用性与安全性研究[J].中外医学研究，2017，15（22）：15-17.
[3] Chang SY，Sun RQ，Feng M，et al. The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy：A prospective randomized-controlled trial [J]. Kaohsiung J Med Sci，2019，35（2）：111-115.
[4] 王忠诚.神经外科学[M].武汉：湖北科学技术出版社，1998．
[5] Van Heurn LW，van Geffen GJ，Brink PR. Clinical experience with percutaneous dilatational tracheostomy：report of 150 cases [J]. Eur J Surg，1996，162（7）：531-535.
[6] Ciaglia P，Firsching R，Syniec C. Elective percutaneous dilatationaltracheostomy: a new simple bedside procedure：preliminary report [J]. Chest，1985，87（6）：715-719.
[7] Byhahn C，Wilke HJ，Halbig S，et al. Percutaneous tracheostomy：ciaglia blue rhino versus the basic ciaglia technique of percutaneous dilational tracheostomy [J]. Anesth Analg，2000，91（4）：882-886．
[8] Frova G，Quintel M. A new simple method for percutaneoustracheostomy: controlled rotating dilatation. A preliminaryreport [J]. Intensive Care Med，2002，28（3）：299-303.
[9] Griggs WM，Worthley LIG，Gilligan JE，et al. A simple percutaneous tracheostomy technique [J]. Surgery，1990，170（6）：543-545.
[10] Vargas M，Sutherasan Y，Antonelli M，et al. Tracheostomy procedures in the intensive care unit：an international survey [J]. Crit Care，2015，19（1）：291.
[11] Al-Shathri Z，Susanto I. Percutaneous Tracheostomy [J]. Semin Respir Crit Care Med，2018，39（6）：720-730.
[12] Rashid AO，Islam S. Percutaneous tracheostomy：a comprehensive review [J]. J Thorac Dis，2017，9 (Suppl 10)：S1128-S1138.
[13] Petzold A，Girbes A. Pain management in neurocritical care [J]. Neurocrit Care，2013，19（2）：232-256.
[14] 董迎春，苏荣祥，吴蔚媚，等.监测麻醉管理在经皮扩张气管切开术中的临床应用[J].华西口腔医学杂志，2011， 29（6）：626-628.
[15] Chang SY，Sun RQ，Feng M，et al. The use of remifentanil in critically ill patients undergoing percutaneous dilatational tracheostomy：A prospective randomized-controlled trial [J]. Kaohsiung J Med Sci，2019，35（2）：111-115.
[16] Saritas A，Saritas PU，Kurnaz MM，et al. The role of fiberoptic bronchoscopy monitoring during percutaneous dilatational tracheostomy and its routine use into tracheotomy practice [J]. J Pak Med Assoc，2016，66（1）：83-89.
[17] 阮正上，江来，任荣荣，等.右美托咪定对喉癌经皮穿刺气管切开术中芬太尼镇静效果的影响[J].广州医学院学报，2015，43（5）：67-70.
[18] Barr J，Fraser GL，Puntillo K. Clinical practice guidelines for the management of pain，agitation，and delirium in adult patients in the intensive care unit [J]. Crit Care Med，2013，41（1）：278-280.
[19] 王娜.舒芬太尼用于经皮气管切开术导致呼吸暂停1例[J].临床合理用药杂志，2016，9（16）：118-119.
[20] 李倩，罗朝志，吉阳，等.咪达唑仑混合芬太尼辅助局部麻醉时改良Wilson镇静分级与呼吸抑制的关系多中心、前瞻性、随机、双盲研究[J].中华麻醉学杂志，2008， 28（10）：954-955.
2020, Vol. 17 
京公网安备 11010502046598号