上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (08): 1098-1102.doi: 10.3969/j.issn.1674-8115.2020.08.016

• 论著·临床研究 • 上一篇    下一篇

小儿磁共振成像检查中咪达唑仑口服复合右美托咪定滴鼻镇静的安全性和有效性

季莹莹，薛 彬，黄 悦，张剑蔚   

  1. 上海交通大学医学院附属上海儿童医学中心麻醉科，上海200127
  • 出版日期:2020-08-28 发布日期:2020-08-28
  • 通讯作者: 张剑蔚，电子信箱：janewei0704@hotmail.com。
  • 作者简介:季莹莹（1987—），女，住院医师，硕士；电子信箱：278676842@qq.com。
  • 基金资助:
    上海市科学技术委员会科研计划项目（17441903200）。

Efficacy and safety of oral midazolam in combination with intranasal dexmedetomidine for paediatric magnetic resonance imaging sedation

JI Ying-ying, XUE Bin, HUANG Yue, ZHANG Jian-wei   

  1. Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2020-08-28 Published:2020-08-28
  • Supported by:
    Scientific Research Project of Shanghai Science and Technology Commission (17441903200).

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摘要： 目的·评估咪达唑仑口服复合右美托咪定滴鼻用于小儿磁共振成像（magnetic resonance image，MRI）检查中镇静的安全性和有效性。方法·将2019年3月—2019年7月于上海交通大学医学院附属上海儿童医学中心拟行MRI检查的186例3～8岁患儿随机分为2组，每组93例，镇静方案分别为口服水合氯醛50 mg/kg复合右美托咪定2 μg/kg滴鼻（水合氯醛组）、口服咪达唑仑0.3 mg/kg复合右美托咪定2 μg/kg滴鼻（咪达唑仑组）。比较2组患儿的镇静成功率、镇静起效时间、苏醒时间、总镇静时间及不良反应发生率。结果·水合氯醛组和咪达唑仑组MRI 检查镇静成功率分别为98.9%和94.6%，差异无统计学意义（P>0.05）。咪达唑仑组镇静起效时间为20.0（10.0，20.0）min，长于水合氯醛组（P=0.000）；其苏醒时间及总镇静时间分别为15.0（3.0，31.8） min和68.0（58.0，82.0） min，较水合氯醛组明显缩短（P=0.000，P=0.001）。咪达唑仑组患儿耐受情况更好，未出现恶心、呕吐。2组均未出现需要临床干预的低血压和心动过缓。结论·口服咪达唑仑复合右美托咪定滴鼻用于小儿MRI检查镇静，患儿耐受良好，苏醒时间更短。该方案可作为一个安全有效的联合用药方案应用于小儿MRI检查。

关键词: 咪达唑仑, 右美托咪定, 磁共振成像, 小儿患者, 镇静

Abstract:

Objective · To evaluate the efficacy and safety of sedation using oral midazolam in combination with intranasal dexmedetomidine for magnetic resonance imaging (MRI) in paediatric patients. Methods · A total of 186 children aged 3–8 years undergoing MRI in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, from March 2019 to July 2019, were randomly assigned to two groups, who received either oral 50 mg/kg chloral hydrate combined with 2 μg/kg intranasal dexmedetomidine (chloral hydrate group, n=93) or oral 0.3 mg/kg midazolam combined with 2 μg/kg intranasal dexmedetomidine (midazolam group, n=93). The efficacy and safety of the sedative regimens were evaluated based on the successful sedation rate, sedation onset time, wake-up time, total sedation time and the incidence of clinical side effects. Results · The successful sedation rates were 98.9% and 94.6% in chloral hydrate group and midazolam group, respectively, with no significant difference (P>0.05). The sedation onset time was 20.0 (10.0, 20.0) min in midazolam group, which was longer than that in chloral hydrate group (P=0.000). The wake-up time was 15.0 (3.0, 31.8) min and the total sedation time was 68.0 (58.0, 82.0) min in midazolam group, both of which were significantly shorter than those in chloral hydrate group (P=0.000, P=0.001). The sedation in midazolam group was better accepted by children who did not experience nausea or vomiting. Hypotension and bradycardia were rare and did not require intervention in either group. Conclusion · Oral midazolam combined with intranasal dexmedetomidine is better accepted by the paediatric patients and the wake-up time of it is shorter, which may be used effectively and safely for sedation during paediatric MRI procedures．

Key words: midazolam, dexmedetomidine, magnetic resonance imaging (MRI), paediatric patient, sedation

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