右美托咪定或氯胺酮复合咪达唑仑在门诊小儿磁共振检查中的镇静作用-现代医学

右美托咪定或氯胺酮复合咪达唑仑在门诊小儿磁共振检查中的镇静作用

单位：1. 徐州市中心医院麻醉科, 江苏徐州 221000;
2. 徐州市儿童医院麻醉科, 江苏徐州 221000

分类号：R614.1

出版年·卷·期（页码）：2021·49·第八期（974-980）

摘要：

目的：对比常规剂量右美托咪定或氯胺酮复合咪达唑仑在门诊小儿核磁共振（MRI）检查中的镇静效果。方法：选取2019年1月至2020年2月于徐州市中心医院门诊就诊须行MRI检查的90例患儿为研究对象，随机分为A组和B组，每组45例。A组应用常规剂量右美托咪定+咪达唑仑，B组应用常规剂量氯胺酮+咪达唑仑。统计2组患儿各部位检查时间和麻醉用药量，对比2组患儿镇静效果（Ramsay评分），比较2组患儿用药前（T₀）、开始MRI检查前（T₁）和检查完成后（T₂）心率（HR）、呼吸频率（RR）、平均动脉压（MAP）和血氧饱和度（SaO₂）水平，对比2组患儿检查结束后睁眼时间、应答时间、苏醒期躁动发生率，比较2组患儿麻醉用药相关不良反应发生情况。结果：2组各部位检查时间和咪达唑仑用药量差异均无统计学意义（P>0.05）。A组镇静诱导后Ramsay评分、镇静满意率与B组差异均无统计学意义（P>0.05）。A组T₀、T₁、T₂时刻HR分别为（111.47±21.30）、（96.54±16.48）、（101.40±17.65）次·min^-1，RR分别为（24.63±5.01）、（19.41±3.65）、（23.15±4.45）次·min^-1，MAP分别为（87.56±16.53）、（69.45±13.71）、（79.32±14.50） mmHg，SaO₂分别为（96.59±18.30）%、（96.87±18.44）%、（96.93±18.40）%；B组T₀、T₁、T₂时刻HR分别为（112.45±22.22）、（98.02±18.46）、（102.53±19.88）次·min^-1，RR分别为（24.28±5.14）、（18.77±3.76）、（23.21±4.50）次·min^-1，MAP分别为（87.48±16.32）、（69.80±12.25）、（78.14±14.55） mmHg，SaO₂分别为（96.28±18.21）%、（96.45±18.61）%、（96.92±18.22）%。HR、RR、MAP经重复测量方差分析差异均有统计学意义（P<0.05）；2组T₁、T₂时刻HR均低于T₀时刻，T₁、T₂时刻MAP均低于T₀时刻，上述差异均有统计学意义（P<0.05）；2组患儿不同时刻HR、RR、MAP、SaO₂差异均无统计学意义（P>0.05）。A组检查后睁眼时间、应答时间均短于B组[（7.52±1.47） min vs（12.08±2.52） min，（10.75±1.85） min vs（17.63±3.20） min]，苏醒期躁动发生率低于B组（2.22%vs 15.56%），差异均有统计学意义（P<0.05）。2组不良反应发生率差异无统计学意义（P>0.05）。结论：右美托咪定复合咪达唑仑在门诊小儿核磁共振检查中的镇静效果、对血流动力学的影响、安全性均与氯胺酮复合咪达唑仑相当，但前者患儿苏醒迅速，且苏醒期躁动发生率低。

Objective: To compare the sedative effect of dexmedetomidine or ketamine combined with midazolam on MRI in outpatients. Methods: 90 children who needed MRI examination in the outpatient department of Xuzhou Central Hospital from January 2019 to February 2020 were selected asstudy objects. All the objects were randomly divided into 2 groups. The 45 sick children were enrolled in group A, and 45 sick children were enrolled in group B.Group A received conventional dose of dexmedetomidine combined with midazolam, while thegroup B received conventional dose of ketamine combined with midazolam. The examination time and anesthetic dosage of the two groups were counted. Sedative effect (Ramsay scores) of the 2 groups were compared. Heart rates (HR), respiratory rates (RR), mean arterial pressures (MAP), and blood oxygen saturation (SaO₂) levels before sedation treatment(T₀), before the beginning of MRI examination(T₁) and at the end of MRI examination(T₂) of the 2 groups were compared. Time to open eyes and response after examination, incidences of restlessness in the wake-up period and occurrence of adverse reactions related to anesthetic drugs of the 2 groups were compared. Results: There was no significant difference in the time of examination and the dosage of midazolam between the two groups (P>0.05). After sedation induction, there were no significant differences in the Ramsay scores and the sedation satisfaction rates between group A and group B (P>0.05). The HR in group A at T₀, T₁ and T₂ were respectively (111.47±21.30)beat·min^-1, (96.54±16.48) beat·min^-1, (101.40±17.65) beat·min^-1, and RR were respectively (24.63±5.01) beat·min^-1, (19.41±3.65) beat·min^-1, (23.15±4.45) beat·min^-1, and MAP were respectively (87.56±16.53) mmHg, (69.45±13.71) mmHg, (79.32±14.50) mmHg, and SaO₂ were respectively (96.59±18.30)%, (96.87±18.44)%, (96.93±18.40)%. The HR in group B at T₀, T₁ and T₂ were respectively (112.45±22.22)beat·min^-1, (98.02±18.46)beat·min^-1, (102.53±19.88) beat·min^-1, and RR were respectively (24.28±5.14)beat·min^-1, (18.77±3.76)beat·min^-1, (23.21±4.50) beat·min^-1, and MAP were respectively (87.48±16.32)mmHg, (69.80±12.25)mmHg, (78.14±14.55) mmHg, and SaO₂ were respectively (96.28±18.21)%, (96.45±18.61)%, (96.92±18.22)%. There were statistically significant differences in HR, RR, MAP by repeated measurement analysis of variance (P<0.05). HR at T₁ and T₂ in both groups were lower than that at T₀, and RR at T₂ was lower than that of T₁, with statistically significant differences (P<0.05). In both groups, MAP at T₁ and T₂ were lower than those at T₀ (P<0.05). There was no significant difference in HR, RR, MAP and SaO₂ at different time points between the 2 groups (P>0.05). Bothtime to open eyes and toresponse in group A were shorter than those in groupB[(7.52±1.47) min vs (12.08±2.52) min, (10.75±1.85)minvs (17.63±3.20) min], of which the incidence of restlessness in the wake-up period was lower than that in groupB (2.22% vs 15.56%), with statistically significant differences (P<0.05). There was no significant difference in theincidences of adverse reactions between the two groups (P>0.05). Conclusion: The sedative effect, hemodynamic effect and safety of dexmedetomidine combined with midazolam in MRI examination of outpatients are similar to those of ketamine combined with midazolam, but the former wakes up quickly and causes lessincidence of restlessness.

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