比较右旋美托咪啶与丙泊酚用于儿童磁共振成像睡眠的研究  

作　　者：Mohamed Mahmoud, MD Joel Gunter, MD Lane F. Donnelly, MD Yu Wang, MS Todd G. Nick, PhD Senthilkumar Sadhasivam, MD, MPH 邝立挺(译) 

机构地区：[1]Department of Anesthesiology ,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio [2]Department of Radiology,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio [3]Division of Biostatistics and Epidemiology,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio [4]不详

出　　处：《麻醉与镇痛》2011年第3期84-92,共9页Anesthesia & Analgesia

摘　　要：背景磁共振成像（MRI）睡眠研究有助于对难治性阻塞性睡眠呼吸暂停（OSA）儿童的保守治疗提供指导。因为OSA儿童容易受到镇静药和麻醉药的影响而引起呼吸抑制；这类患者行影像学检查时的麻醉具有挑战性。右旋美托咪啶（Dexmedetomidine）已经被证实具有模拟自然睡眠而51起最小呼吸抑制的药理效应。我们假定，与丙泊酚相比，右旋美托咪啶较少引起上呼吸道张力的增加和塌陷，对患有OSA的儿童进行动态MRI气道影像学检查时提供更多有利条件，减少扫描中断和气道干预处理。方法在这项回顾描述性研究中，我们收集了2006年7月至2008年3月，52例采用右旋美托咪啶麻醉和30例采用丙泊酚麻醉行MRI睡眠研究的儿童资料。82个病例中的67例可通过全夜过程多导睡眠描记法记录OSA的严重程度，需要进行单独分析。数据分析包括：人口统计学特征、OSA严重程度、合并症、血流动力学改变、人工气道的使用、附加的气道操作和MRI扫描是否成功完成。结果两组病例在人口统计学特征、多导睡眠描记法记录的OSA严重程度、麻醉诱导、基础血流动力学方面都相似。98％的右旋美托咪啶组儿童和100％的丙泊酚组儿童能完成MRI的睡眠研究。在82例儿童中，右旋美托咪啶组中的46例（88．5％）和丙泊酚组中的21例（70％）不需使用人工气道而成功完成研究（P=0．03）。右旋美托咪啶组中5例（12％）和丙泊酚组中的9例（35％）需要使用人工气道才能完成该项研究（P=0．06）。右旋美托咪啶组中的1例（2％）和丙泊酚组中的3例（35％）需要附加的气道处理（托起下颌和垫起肩部）来完成该项监测（P=0．14）。右旋美托咪啶组中的儿童出现心率下降，而丙泊酚组中的儿童出现动脉血压下降，这些下降具有统计学意义，但并没有临床意义。结论右旋美托咪啶可为OSA儿童行BACKGROUND： Magnetic resonance imaging （MRI） sleep studies can be used to guide management of children with obstructive sleep apnea （OSA） refractory to conservative therapy. Because children with OSA are sensitive to the respiratory-depressant effects of sedatives and anesthetics, provision of anesthesia for imaging studies in this patient population can be challenging. Dexmedetomidine has been shown to have pharmacological properties simulating natural sleep with minimal respiratory depression. We hypothesized that, compared with propofol, dexmedetomidine would have less effect on upper airway tone and airway collapsibility, provide more favorable conditions during dynamic MRI airway ima- ging in children with OSA, have fewer scan interruptions, and require less aggressive airway interventions. METHODS： In this retrospective descriptive study, we reviewed the records of 52 children receiving dexmedetomidine and 30 children re- ceiving propofol for anesthesia during MRI sleep studies between July 2006 and March 2008. Documentation of the severity of OSA by overnight polysomnography was available for 67 of the 82 subjects, who were analyzed separately. Data analyzed included demographics, severity of OSA, comorbidities, hemodynamic changes, use of artificial airways, additional air- way maneuvers, and successful completion of the Mill scan. RESULTS： Demographics, OSA severity by polysomnography, anesthetic induction, and baseline hemodynamics were comparable in both groups. An interpretable MRI sleep study was obtained for 98% of children in the dexmedetomidine group and 100% in the propofol group. Of 82 children, MRI sleep studies were successfully completed without the use of artificial airways in 46 children （ 88.5% ） in the dexmedetomidine group versus 21 children （ 70% ） in the propofol group （P = 0. 03 ）. An artificial airway was required to complete the study in five children （ 12% ） in the dexmedetomidine group versus nine children （35%） in the propofol group （P = 0.06�

关 键 词：阻塞性睡眠呼吸暂停 右旋美托咪啶 磁共振成像 丙泊酚 儿童 多导睡眠描记法 动态MRI 影像学检查 

分 类 号：R766.43[医药卫生—耳鼻咽喉科]