异丙酚与右美托咪定对于磁共振检查中镇静困难患儿应用的对比研究

Sedation of Difficult-to-Sedate Patients during Pediatric Diagnostic MR:Comparison of Dexmedetomidine and Propofol

目的比较对于MR检查中水合氯醛和苯巴比妥镇静失败的患儿,应用异丙酚和右美托咪定的成功率,及副反应的发生率。方法本实验选择2010年3月至2011年2月在我院行MR检查,而且口服水合氯醛或静脉注射苯巴比妥镇静失败的儿童共641例,给予其家长在MR检查期间选择异丙酚或右美托咪定进行镇静的权利。289名患儿接受异丙酚输注,352名接受了右美托咪定输注。记录镇静成功率,需要气道维护的发生率、呼吸系统副反应的发生率以及镇静结束后苏醒时间,采用Fisher精确检验(Fisher exact test)以及t检验比较异丙酚和右美托咪定组镇静成功率、需要气道维护的发生率、呼吸系统副反应的发生率以及镇静结束后苏醒时间的差异。结果右美托咪定组患儿镇静失败的发生率显著高于异丙酚组(8.2%vs 2.8%P<0.05).异丙酚组患儿需要需要辅助手段保持气道通畅的概率显著高于右美托咪定组(7.6%vs 3.7%,P<0.05);镇静维持期间两组组气道副反应发生率没有显著差异(2.4%vs 1.1%,P>0.05)。镇静后苏醒时间异丙酚组显著短于右美托咪定组(28±11 vs 39±13,P<0.001)。结论对水合氯醛或苯巴比妥镇静困难的患儿,异丙酚镇静成功率更高,而右美托咪定有着更高的安全性。

【Objective】 To compare propofol and dexmedetomidine in the effectiveness,incidence of adverse respiratory events,the need for airway interventions,and the recovery time after sedation for sedation of patients who were difficult to be sedated with oral pentobarbital or oral chloral hydrate during pediatric diagnostic MR.【Methods】 METHOD AND MATERIALS： This study was conducted with institutional review board approval and parental informed consent.Between March 2010 and Feburary 2011,parents whose child could not be sedated with oral pentobarbital or oral chloral hydrate were given the choice of having their child sedated with intravenously dexmedetomidine or propofol during pediatric diagnostic MR.289 patients（128 female,161 male;mean age,6.3± 2.1 years） received sedation with propofol,352 patients（165 female,187 male;mean age,5.9 ± 1.8 years） with dexmedetomidine.All sedatives were administered by a radiology nurse under the supervision of an anesthesiologist.The effectiveness,airway manipulations,adverse respiratory events,and recovery time after sedation were measured between the groups by using the Fisher exact test and the u test.A two-tailed P value of less than 0.05 indicated a significant difference between groups.【Results】 More children failed to be sedated with dexmedetomidine than with propofol（8.2% vs 2.8% P0.05）.Children sedated with propofol during induction underwent significantly more airway manipulations to relieve obstruction than with dexmedetomidine（7.6% vs 3.7%,P0.05）.There were no significant differences between two groups in incidence of adverse respiratory events（2.4% vs 1.1%,P 0.05）.Children in the propofol group had a faster recovery profile than did children in the dexmedetomidine group（28 minutes±11 vs 39 minutes±13,P 0.05）.【Conclusion】 Dexmedetomidine is associated with a lesser incidence of adverse respiratory events,and propofol is more effective for patients who were difficult to be sedated with oral pentobarbital or oral chloral hydrate during pediatric diagnostic MR.