右美托咪定复合不同剂量氯胺酮滴鼻在小儿MRI检查的镇静效果

Sedative effect of Dexmedetomidine combined with different doses of ketamine intranasal in children's MRI examination

目的探讨右美托咪定复合不同剂量氯胺酮滴鼻在小儿核磁共振(MRI)检查时的镇静效果。方法 90例接受MRI检查患儿随机将其分为3组,D1组(2μg/kg右美托咪定+1 mg/kg氯胺酮)、D2组(2μg/kg右美托咪定+2 mg/kg氯胺酮)、C组(2μg/kg右美托咪定);记录三组患儿一般情况、检查成功率、入睡和苏醒时间、不良反应发生情况及在经鼻给药前(T0)、经鼻给药后1 min(T1)、入睡时(T2)、检查前(T3)、检查完成时(T4)、患儿苏醒即刻(T5)不同时间的心率(HR)、氧饱和度(SPO2)。结果 D2组患儿镇静一次成功率高于D1组和C组,差异有统计学意义(P<0.05);D2组患儿较D1组和C组追加丙泊酚的次数明显减少,且D1组和C组均有患儿呼吸抑制情况;D2组患儿入睡时间明显短于D1组和C组,差异有统计学意义(P<0.05);D2组、D1组患儿较C组患儿苏醒时间延长,差异有统计学意义(P<0.05)。T2、T3、T4时刻,三组患儿的HR均较T0时刻明显降低,差异均有统计学意义(P<0.05)。结论 2μg/kg右美托咪定+2 mg/kg氯胺酮滴鼻在小儿镇静中起效更快,效果更佳,且安全可靠。

Objective To investigate the sedative effect of dexmedetomidine combined with different doses of ketamine intranasal in childreng MRI examination. Methods Totally 90 cases underwent MRI were randomly divided into three groups, group Dj （21μg/kg dexmedetomidine ＋ 1mg/kg ketamine） ,group D2 （2μg/kg dexmedetomidine ＋ 2mg/kg ketamine）, C （21μg/kg dexmedetomidine） ; Records of three groups of children in general, the success rate, sleep time and recovery time, and the adverse reactions. The values of HR, SPO2 of the three groups were recorded before in- tranasal （ TO ） , 1 min after intranasal （ T1 ） and sleep （ T2 ） , before the examination （ T3 ） , after the examination （ T4） and recovery （ Ts ）. Results D2 sedation was higher than that of D1 and C group in the success rate （ P 〈 0. 05 } ; The number of propofol in D2 group was significantly reduced compared with D1 group and C group; There were several respiratory depression children in D1 and C groups; Compared with D1 and C group it was significantly shorter about the sleep time in D2 group （ P 〈0. 05 ） ; compared with C group it was prolonged in recovery time of D2 and Dl group （P 〈0. 05 ）. The HR of the three groups at the time of T2, Ts , and T4 was significantly lower than those at the To （P 〈 0. 05）. Conclusion Compared with other group , intranasal drops of 2g/kg dexmedetomidine ＋ 2mg/kg produces fasters onset and better effect in children＇ sedation. And the safty is reliable.