右旋美托咪啶-咪达唑仑与丙泊酚用于小儿磁共振检查中麻醉维持的比较  

作　　者：Christopher Heard, MBChB, FRCA Frederick Burrows, MD Kristin Johnson, PharmD Prashant Joshi, MD James Houck, MD Jerrold Lerman FRCPC, FANZCA 马敏(译) 江海星(译) 饶艳(校) 王焱林(校) 

机构地区：[1]Department of Anesthesiology and Division of Pediatric Critical Care, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, Buffalo, New York [2]Department of Anesthesiology, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, Buffalo, New York [3]Department of Pharmacy, Women and Children's Hospital of Buffalo, Buffalo, New York [4]Division of Pediatric Critical Care, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, Buffalo, New York [5]Department of Anesthesiology, Women and Children's Hospital of Buffalo, Buffalo, New York [6]State University of New York at Buffalo and University of Rochester, Rochester, New York [7]Department of Anesthesiology, Women and Children's Hospital of Buffalo, Buffalo and Strong Memorial Hospital, Rochester, New York [8]不详

出　　处：《麻醉与镇痛》2010年第2期49-56,共8页Anesthesia & Analgesia

摘　　要：背景右旋美托咪啶是一种仪，受体激动剂，目前正在研究其是否适合用于小儿麻醉。本研究旨在比较右旋美托咪啶一咪达唑仑与丙泊酚对于七氟烷麻醉儿童磁共振扫描（M对）中的药效学反应差异。方法40例1～10岁，ASA1或2级，拟行MRI检查的患儿，随机分为2组，两组均用七氟烷诱导，一组以右旋美托咪啶．咪达唑仑维持麻醉，另一组以丙泊酚维持麻醉。右旋美托咪啶组先静注负荷量（1μg／kg）后持续泵入（0．5μg·kg^-1·h^-1）。开始泵注后静注咪达唑仑（0．1mg／kg）。丙泊酚持续泵入（250—300μg·kg^-1·min^-1）。由一名不了解麻醉方案的护士来记录复苏时间及血流动力学变化。结果右旋美托咪啶组手术后完全恢复及出院时间明显长于（约15分钟）丙泊酚组。与丙泊酚组比较，右旋美托咪啶组心率减慢，收缩压增高。两组呼吸系统指标相近。恢复过程中，两组血流动力学反应相近。在麻醉及手术后恢复过程中，心肺指标均在同年龄段儿童的正常范围内。无麻醉意外发生。结论在MRＩ检查中，右旋美托咪啶．咪达唑仑提供足够的麻醉深度，但-I丙泊酚相比麻醉复苏时间稍长。与丙泊酚组比较，使用右旋美托咪啶的患儿心率慢、收缩压高。两种方式的呼吸系统指标相近。BACI（GROUND： Dexmedetomidine is an % agonist that is currently being investigated for its suitability to provide anesthesia for children. We compared the pharmacodynamic responses to dexmedetomidine-midazolam and propofol in children anesthetized with sevoflurane undergoing magnetic resonance imaging （MRI）. METHODS： Forty ASA 1 or 2 children, 1 - 10 yr of age, were randomized to receive either dexmedetomidine-midazolam or propofol for maintenance of anesthesia for MRI after a sevoflurane induction. Dexmedetomidine was administered as an initial loading dose （1μg/kg） followed by a continuous infusion （0. 5 μg · kg^- 1 . h^- 1 ）, Midazolam （0, 1 mg/kg） was administered IV when the infusion com- menced, Propofol was administered as a continuous infusion （250 - 300 8μg · kg^-1· min^-1）, Recovery times and hemodynam- ic responses were recorded by one nurse who was blinded to the treatments. RESULTS： We found that the times to fully recover and to discharge from the ambulatory unit after dexmedetomidine administration were significantly greater （by 15 min） than those after propofol. Analysis of variance demonstrated that heart rate was slower and systolic blood pressure was greater with dexmedetomidine than propofol. Respiratory indices for the two treatments were similar. During recovery, hemodynamic responses were similar. Cardiorespiratory indices during anesthesia and recovery remained within normal limits for the children＇s ages. No adverse events were recorded. CONCLUSIONS： Dexmedetomidine-midazolam provides adequate anesthesia for MRI although recovery is prolonged when compared with propofol. Heart rate was slower and systolic blood pressure wasgreater with dexmedetomidine when compared with propofol. Respiratory indices were similar for the two treatments.

关 键 词：右旋美托咪啶 咪达唑仑 麻醉维持 丙泊酚 小儿麻醉 磁共振检查 血流动力学反应 血流动力学变化 

分 类 号：R971.93[医药卫生—药品]