右美托咪定与咪达唑仑在急性呼吸衰竭患儿无创持续气道正压通气的比较研究  

Comparative study of dexmedetomidine and midazolam for noninvasive continuous positive airway pressure in children with acute respiratory failure

作　　者：贺杰[1] 张新萍[1] 周雄[1] 蔡姿丽[1] 康霞艳 段蔚[1] 赵文姣[1] 肖政辉[1] He Jie;Zhang Xinping;Zhou Xiong;Cai Zili;Kang Xiayan;Duan Wei;Zhao Wenjiao;Xiao Zhenghui(Emergency Center,Hunan Children′s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院急救中心,长沙410007

出　　处：《国际儿科学杂志》2021年第8期568-573,共6页International Journal of Pediatrics

基　　金：儿童急救医学湖南省重点实验室(2018TP1028)。

摘　　要：目的:比较右美托咪定与咪达唑仑用于儿童急性呼吸衰竭无创持续气道正压通气(noninvasive continuous positive airway pressure,NCPAP)的有效性及安全性。方法:前瞻性收集湖南省儿童医院PICU 2018年1月~2020年3月行NCPAP并需镇静治疗的急性呼吸衰竭患儿病例资料。随机分为右美托咪定组(D组)和咪达唑仑组(M组),共100例患儿入组。比较两组镇静后0.5 h(t1)、1 h(t2)、2 h(t3)、6 h(t4)、12 h(t5)、24 h(t6)、48 h(t7)7个时间点的镇静深度、达适宜镇静时间、NCPAP时间、NCPAP失败率、镇静前(T0)和镇静后1 h(T1)、24 h(T2)、48 h(T3)的氧合指数(P/F值)及主要生命体征,以及不良反应。结果:(1)D组T4、T5、T6、T7时适宜镇静比例高于M组[98%(49/50)比84%(42/50)、94%(47/50)比90%(45/50)、96%(48/50)比88%(44/50)、90%(45/50)比88%(44/50),χ^(2)=6.538、8.043、8.174、7.678,P均<0.05],差异均有统计学意义;M组与D组相比,达到适宜镇静时间明显缩短[(58.6±7.9)s比(66.7±9.3)s,t=4.682,P<0.01];(2)D组NCPAP治疗时间、失败率低于M组[(134.9±25.5)h比(147.8±24.3)h、10%(5/50)比28%(14/50),P均<0.05];两组治疗后P/F值均较治疗前改善(P均<0.01),D组T2、T3时P/F值较M组改善更显著[(199.3±26.1)mmHg比(188.5±24.2)mmHg(1 mmHg=0.133 kPa)、(212.2±25.4)mmHg比(200.8±24.8)mmHg,t=2.132、2.278,P均<0.05];(3)两组镇静前心率(HR)、平均动脉压(MAP)、呼吸频率(RR)比较差异无统计学意义(P均>0.05);两组镇静后HR、RR均较镇静前下降(P<0.01),D组T1、T2、T3时的HR较M组明显下降更显著[(116.3±17.6)次/min比(124.8±14.1)次/min、(110.2±18.4)次/min比(121.9±15.2)次/min、(108.5±18.7)次/min比(117.6±12.8)次/min,t=0.479、-3.474、-2.840,P均<0.05];两组镇静后RR比较差异无统计学意义(t=1.872、1.632、1.675,P均>0.05);D组T1时MAP较T0下降(P<0.01),D组T1时MAP低于M组[(65.5±5.1)mmHg比(68.0±5.7)mmHg,t=-2.297,P=0.024];(4)两组不良反应发生率比较差异无统计学意义[20%(10/50)比14%(7/50),PObjective To investigate the efficacy and safety of dexmedetomidine in noninvasive continuous positive airway pressure(NCPAP)for acute respiratory failure in children.Methods Clinical data of children with acute respiratory failure who underwent NCPAP from January 2018 to March 2020 in PICU of Hunan Children′s Hospital were prospectively collected.They were randomly divided into dexmedetomidine group(group D)and midazolam group(group M),with a total of 100 children.We compared the sedation depth of the two groups at 7 time points after sedation at 0.5 h(t1),1 h(t2),2 h(t3),6 h(t4),12 h(t5),24 h(t6),and 48 h(t7),time to reach proper sedation,NCPAP time,NCPAP failure rate,oxygenation index(P/F value)before sedation(T0)and 1h(T1),24h(T2),and 48h(T3)after sedation,and the main vital signs and adverse reactions before sedation(T0)and 1h(T1),24h(T2),48h(T3)after sedation.Results(1)The proportion of proper sedation at T4,T5,T6 and T7 after sedation in group D was higher than that in group M[98%(49/50)vs.84%(42/50),94%(47/50)vs.90%(45/50),96%(48/50)vs.88%(44/50),90%(45/50)vs.88%(44/50),χ^(2)=6.538,8.043,8.174,7.678,all P<0.05].Time to reach proper sedation in group D was shorter[(58.6±7.9)s vs.(66.7±9.3)s,t=4.682,P<0.01].(2)The treatment time and failure rate of NCPAP in group D were lower than those in group M[(134.9±25.5)h vs.(147.8±24.3)h,10%(5/50)vs.28%(14/50),all P<0.05].P/F after NCPAP treatment in the two groups was improved as compared with that before treatment(all P<0.01),and the improvement was more significant in group D than in group M at T2 and T3 after sedation[(199.3±26.1)vs.(188.5±24.2)mmHg,(212.2±25.4)mmHg vs.(200.8±24.8)mmHg,t=2.132,2.278,all P<0.05].(3)There were no significant differences in heart rate(HR),mean arterial pressure(MAP),and respiratory rate(RR)before sedation between the two groups(all P>0.05).HR and RR after sedation in both groups decreased as compared with those before sedation(P<0.01).HR at T1,T2,and T3 after sedation in group D decreased more significantly than that in g

关 键 词：右美托咪定 急性呼吸衰竭 无创持续气道正压通气 咪达唑仑 镇静 

分 类 号：R726.1[医药卫生—儿科]