Irazuzta J, Pascucci R, Perlman N, Wessel D
Department of Pediatrics, West Virginia University Health Science Center, Women & Children's Hospital, Charleston, WV.
Crit Care Med. 1993 Jul;21(7):1001-4. doi: 10.1097/00003246-199307000-00013.
To determine if the analgesic doses of fentanyl used in a pediatric intensive care unit (ICU) setting adversely affect dynamic total respiratory system compliance in awake, intubated infants.
Prospective case-control study.
Pediatric and pediatric cardiac ICUs of a tertiary university hospital.
Thirteen awake and mechanically ventilated children < 6 months of age.
Measurements of dynamic total respiratory system compliance were obtained during steady-state conditions for 6 mins and continued for 10 mins after the rapid, intravenous administration of 4 micrograms/kg of fentanyl. No patient had received a narcotic, benzodiazepine, or muscle relaxant within the previous 4 hrs.
After fentanyl administration, dynamic total respiratory system compliance was unchanged in three patients, improved in nine patients, and deteriorated in one patient. The mean value for the entire group increased from 0.76 mL/cm H2O/kg before infusion to 0.82 mL/cm H2O/kg after infusion (p < .02), representing a 9.6% increase. None of the patients showed oxygen desaturation as assessed by continuous pulse oximeter, or episodes of chest wall rigidity.
This work corroborates our clinical impression that rapid infusions of fentanyl at the dose tested in small infants do not adversely affect dynamic total respiratory system compliance. To the contrary, the sedating and analgesic effects may improve synchronous breathing and decrease voluntary muscle tone, resulting in improved dynamic total respiratory system compliance.
确定儿科重症监护病房（ICU）中使用的芬太尼镇痛剂量是否会对清醒、插管婴儿的动态总呼吸系统顺应性产生不利影响。
前瞻性病例对照研究。
一所三级大学医院的儿科和小儿心脏ICU。
13名年龄小于6个月、清醒且接受机械通气的儿童。
在稳态条件下测量动态总呼吸系统顺应性6分钟，并在快速静脉注射4微克/千克芬太尼后持续测量10分钟。在过去4小时内，没有患者接受过麻醉剂、苯二氮䓬类药物或肌肉松弛剂。
注射芬太尼后，3例患者的动态总呼吸系统顺应性未变，9例患者改善，1例患者恶化。整个组的平均值从输注前的0.76毫升/厘米水柱/千克增加到输注后的0.82毫升/厘米水柱/千克（p < 0.02），增加了9.6%。通过连续脉搏血氧饱和度仪评估，没有患者出现氧饱和度下降或胸壁僵硬的情况。
这项研究证实了我们的临床印象，即在小婴儿中以测试剂量快速输注芬太尼不会对动态总呼吸系统顺应性产生不利影响。相反，镇静和镇痛作用可能会改善同步呼吸并降低自主肌张力，从而提高动态总呼吸系统顺应性。
