盐酸右美托咪定联合咪达唑仑在儿童纤维支气管镜检查中的安全性和有效性——前瞻性随机对照研究  

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children:a prospective randomized controlled study

作　　者：张进[1] 刘杰波[1] 曾芬娜 任俏[1] 林惠玲 简丽丽 刘国乐[1] ZHANG Jin;LIU Jie-Bo;ZENG Fen-Na;REN Qiao;LIN Hui-Ling;JIAN Li-Li;LIU Guo-Le(Department of Pediatrics,Shenzhen Luohu People's Hospital,Shenzhen,Guangdong 518000,China)

机构地区：[1]深圳市罗湖区人民医院儿科,广东深圳518000

出　　处：《中国当代儿科杂志》2021年第10期981-986,共6页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨盐酸右美托咪定联合咪达唑仑在儿童纤维支气管镜(简称纤支镜)检查中的安全性和有效性。方法选取2018年9月至2021年2月拟行纤支镜检查的患儿118例为研究对象,采用随机数字表法将患儿分为对照组(n=60)和观察组(n=58)。观察组静脉泵注盐酸右美托咪定(1μg/kg,浓度为2μg/mL)后再静脉推注0.05 mg/kg咪达唑仑,10 min后以0.5~0.7μg/(kg·h)静脉泵注盐酸右美托咪定维持麻醉。对照组静脉泵注丙泊酚(2 mg/kg)后静脉推注0.05 mg/kg咪达唑仑,10 min后以4~6 mg/(kg·h)静脉泵注丙泊酚维持麻醉。患儿失去意识后行纤支镜检查。分别在入镜前(T_(0))、放镜时(T_(1))、纤支镜到达声门(T_(2))、纤支镜到达隆突(T_(3))及进入支气管(T_(4))各时间点记录患儿心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、血氧饱和度(pulse oxygen saturation,SpO_(2))和平均动脉压(mean arterial pressure,MAP);并记录术中呼吸道峰压值(peak pressure,Ppeak)、检查时间、镇静程度、遗忘程度、不良反应发生情况及术后苏醒时间和术后躁动评分。结果观察组患儿在T_(1)~T_(4)期间MAP均较对照组显著降低,在T_(1)~T_(3)期间HR均较对照组显著降低(P<0.05)。对照组在T_(1)~T_(4)时MAP均较T_(0)时显著增加,观察组在T_(3)时MAP较T_(0)时显著增加(P<0.05);对照组在T_(1)~T_(3)时HR均较T_(0)时显著增加(P<0.05)。观察组术中Ppeak值、术中不良反应发生率及术后躁动评分均显著低于对照组,检查时间短于对照组,术后遗忘率及麻醉优良率显著高于对照组(P<0.05),但术中镇静程度及术后苏醒时间比较,差异无统计学意义(P>0.05)。结论盐酸右美托咪定联合咪达唑仑全身麻醉可用于患儿纤支镜检查,检查过程中患儿生命体征稳定,并能有效减少术中不良反应及术后躁动的发生,缩短检查时间,提高对检查过程中不适方面的遗忘率,安全有效。Objective To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.Methods A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled.They were divided into a control group(n=60)and an observation group(n=58)using a random number table.The observation group received intravenous pumping of dexmedetomidine hydrochloride(2μg/mL)at 1μg/kg and then intravenous injection of midazolam at 0.05 mg/kg,followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7μg/(kg·h)10 minutes later to maintain anesthesia.The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg,followed by propofol pumped intravenously at 4-6 mg/(kg·h)10 minutes later to maintain anesthesia.Fiberoptic bronchoscopy was performed after the children were unconscious.Heart rate(HR),respiratory rate,blood oxygen saturation,and mean arterial pressure(MAP)were recorded before inserting the bronchoscope(T_(0)),at the time of inserting the bronchoscope(T_(1)),when the bronchoscope reached the glottis(T_(2)),when the bronchoscope reached the carina(T_(3)),and when the bronchoscope entered the bronchus(T_(4)).The intraoperative peak airway pressure(Ppeak),examination time,degree of sedation,extent of amnesia,incidence of adverse reactions,postoperative awakening time,and postoperative agitation score were also recorded.Results Compared with the control group,the observation group had significantly decreased MAP at T_(1)to T_(4)and HR at T_(1)to T_(3)(P<0.05).Compared with that at T_(0),MAP was significantly increased at T_(1)to T_(4)in the control group and at T_(3)in the observation group(P<0.05).HR was significantly higher at T_(1)to T_(3)than at T_(0)(P<0.05).Compared with the control group,the observation group showed significantly lower intraoperative Ppeak value,incidence of intraoperative adverse reactions,and postoperative agitation sc

关 键 词：纤维支气管镜 盐酸右美托咪定 咪达唑仑 儿童 

分 类 号：R726.1[医药卫生—儿科]