小剂量右美托咪定联合丙泊酚用于小儿门诊核磁共振检查镇静的临床研究

doi:10.3877/cma.j.issn.1674-0793.2020.03.012

目的

评价小剂量右美托咪定联合丙泊酚用于小儿门诊核磁共振检查（MRI）镇静的临床应用。

方法

选取2019年1月至3月在广州市妇女儿童医疗中心行门诊MRI需要镇静的患儿300例，随机分为三组：水合氯醛镇静组（H组，口服10%水合氯醛镇静）；丙泊酚静脉镇静组（P组，静脉推注丙泊酚镇静）；小剂量右美托咪定联合丙泊酚静脉镇静组（DP组，右美托咪定0.3 μg/kg+丙泊酚静脉镇静），各100例。比较三组患者的镇静成功率，镇静效果，呕吐、躁动发生率，呼吸抑制率。

结果

P组及DP组的镇静成功率明显高于H组（χ²=18.560，P<0.001），呕吐、躁动发生率明显低于H组（χ²=54.224、17.023，P<0.001、0.001），三组呼吸抑制发生率及需要呼吸支持例数差异无统计学意义（χ²=1.049、1.798，P=0.591、0.407）。DP组需追加丙泊酚例数明显少于P组（χ²=67.520，P<0.001）。镇静过程中，P组及DP组镇静起效时间、苏醒时间、苏醒至离院时间明显短于H组（F=634.100、243.800、42.930，P<0.001、<0.001、<0.001）。

结论

小剂量右美托咪定联合丙泊酚静脉镇静用于小儿门诊MRI检查，具有起效快、不良反应少、安全性高、苏醒快等优点，可在小儿门诊镇静推广应用。

关键词: 儿童, 药物镇静, 核磁共振，生物分子, 右美托咪定, 丙泊酚

Objective

To assess the clinical application of low-dose dexmedetomidine combined with propofol for sedation in pediatric outpatient MRI.

Methods

From January 2019 to March 2019, three hundred children who needed sedation for outpatient MRI in Guangzhou Women and Children's Medical Center were randomly divided into three groups: chloral hydrate sedation group (group H, oral take 10% chloral hydrate sedation), propofol sedation group (group P, propofol iv), and low-dose dexmedetomidine combined with propofol sedation group (group DP, dexmedetomidine 0.3 μg/kg iv + propofol iv), 100 cases in each group. The success rate of sedation, sedation effect, incidence of vomiting, agitation and respiratory inhibition were compared among the three groups.

Results

The sedation success rate of group P and group DP was significantly higher than that of group H (χ²=18.560, P<0.001), while the incidence of vomiting and agitation was significantly lower (χ²=54.224, 17.023; P<0.001, 0.001). There were no significant differences in the incidence of respiratory depression and the number of cases requiring respiratory support among the three groups (χ²=1.049, 1.798; P=0.591, 0.407). The number of cases requiring propofol was significantly less in group DP than in group P during the sedation (χ²=67.520, P<0.001).The sedation onset time and recovery time and discharge time of group P and group DP were significantly shorter than those of group H (F=634.100, 243.800, 42.930, all P<0.001).

Conclusion

Low-dose dexmedetomidine combined with propofol intravenous sedation for MRI examination in pediatric outpatient clinics has such advantages as fast onset, fewer adverse reactions, high safety, quick recovery, and can be widely used in pediatric sedation.

Key words: Child, Conscious sedation, Nuclear magnetic resonance, biomolecular, Dexme-detomidine, Propofol

表1 三组患儿门诊核磁共振检查镇静不良反应情况的比较［例(%)］

组别	例数	镇静失败	呼吸抑制	心动过缓	心动过速	呕吐	躁动	需要呼吸干预	需要追加丙泊酚
H组	100	9(9.0)	6(6.0)	2(2.0)	32(32.0)	28(28.0)	14(4.0)	3(3.0)	—
P组	100	0(0)	5(5.0)	3(3.0)	5(5.0)	2(2.0)	2(2.0)	4(4.0)	76(76.0)
DP组	100	0(0)	3(3.0)	4(4.0)	2(2.0)	0(0)	2(2.0)	1(1.0)	18(18.0)
χ²值	?	18.560	1.049	0.687	48.282	54.224	17.023	1.798	67.520
P值	?	<0.001	0.591	0.709	<0.001	<0.001	<0.001	0.407	<0.001

表1 三组患儿门诊核磁共振检查镇静不良反应情况的比较［例(%)］

组别	例数	镇静失败	呼吸抑制	心动过缓	心动过速	呕吐	躁动	需要呼吸干预	需要追加丙泊酚
H组	100	9(9.0)	6(6.0)	2(2.0)	32(32.0)	28(28.0)	14(4.0)	3(3.0)	—
P组	100	0(0)	5(5.0)	3(3.0)	5(5.0)	2(2.0)	2(2.0)	4(4.0)	76(76.0)
DP组	100	0(0)	3(3.0)	4(4.0)	2(2.0)	0(0)	2(2.0)	1(1.0)	18(18.0)
χ²值	?	18.560	1.049	0.687	48.282	54.224	17.023	1.798	67.520
P值	?	<0.001	0.591	0.709	<0.001	<0.001	<0.001	0.407	<0.001

表2 三组患儿门诊核磁共振检查镇静时间的比较（min,±s ）

组别	例数	镇静起效时间	MRI检查时间	检查结束至苏醒时间	苏醒至离院时间
H组	100	15.1±5.5	15.3±5.3	20.1±5.7	35.1±5.9
P组	100	0.5±0.1	15.2±5.7	10.2±2.6	30.2±5.8
DP组	100	2.5±0.3	16.1±5.1	8.0±3.2	27.7±5.5
F值	?	634.100	0.826	243.800	42.930
P值	?	<0.001	0.439	<0.001	<0.001

表2 三组患儿门诊核磁共振检查镇静时间的比较（min,±s ）

组别	例数	镇静起效时间	MRI检查时间	检查结束至苏醒时间	苏醒至离院时间
H组	100	15.1±5.5	15.3±5.3	20.1±5.7	35.1±5.9
P组	100	0.5±0.1	15.2±5.7	10.2±2.6	30.2±5.8
DP组	100	2.5±0.3	16.1±5.1	8.0±3.2	27.7±5.5
F值	?	634.100	0.826	243.800	42.930
P值	?	<0.001	0.439	<0.001	<0.001

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Clinical study of low-dose dexmedetomidine combined with propofol for sedation in pediatric outpatient MRI

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Clinical study of low-dose dexmedetomidine combined with propofol for sedation in pediatric outpatient MRI