静脉输注右美托咪啶与咪达唑仑用于患儿术前用药效果的比较

Comparison of intravenous infusion of dexmedetomidine and midazolam for premedication in children

目的比较静脉输注右美托咪啶与咪达唑仑用于患儿术前用药的效果。方法择期行普通外科或泌尿外科手术的患儿92例，年龄1．6岁，其中1～3岁及4～6岁儿童各46例，ASA分级I或Ⅱ级，按年龄段分层后随机分为2组（n=46）：咪达唑仑组（M组）和右美托咪啶组（D组）。于麻醉诱导前约20min由家长陪同进入麻醉准备室，分别于10min内静脉输注咪达唑仑0．1mg／kg或右美托咪啶1μg／kg。采用异丙酚-罗库溴铵．瑞芬太尼行麻醉诱导，七氟醚-瑞芬太尼-罗库溴铵维持麻醉。于用药前（T1）、与家长分离（T2）和进入手术室（T3）时记录改良耶鲁术前焦虑评分（mYPAS）、镇静评分、HR、MAP、RR、SpO2。于T2-3时记录患儿进入睡眠状态（镇静评分4分）的发生情况。记录七氟醚呼气末浓度（CetSev）、瑞芬太尼输注速率、拔除喉罩时间、意识恢复时间 、麻醉恢复室观察时间、苏醒期谵妄发生率、补救镇痛药使用率及不良反应的发生情况。结果与T1时比较，两组T2-3时mYPAS评分降低、镇静评分升高，D组T2时HR及T2-3时MAP降低，M组L时HR升高（P〈0．05）；与M组比较，D组T2-3时镇静评分和睡眠发生率升高，T2时HR降低（P〈0．05），mYPAS评分、RR、MAP、SpO2、CetSev、瑞芬太尼输注速率、拔除喉罩时间、意识恢复时间、麻醉恢复室观察时间、苏醒期谵妄发生率、补救镇痛药使用率、不良反应发生率比较差异无统计学意义（P〉0．05）。结论静脉输注右美托咪啶用于患儿术前用药的镇静效果优于咪达唑仑，但对血流动力学的影响强于咪达唑仑，需注意血流动力学的变化。

Objective To compare the efficacy of intravenous infusion of dexmedetomidine and midazolam for premedication in children. Methods Ninety-two ASA 1 or U children （46 cases aged 1-3 yr and 46 cases aged 4-6 yr） scheduled for elective general or urologic surgeries, were enrolled in this study. The children were randomly divided into 2 groups （n = 46 each）： midazolam group （group M） and dexmedetomidine group （group D）. The children accompanied by their parents were admitted to the anesthesia preparation room at about 20 rain before induction of anesthesia, and midazolam 0.1 mg/kg or dexmedetomidine 1 μg/kg was infused intravenously over 10 min. Anesthesia was induced with proporol-rocuroniume-remifentanil, and maintained with sevoflurane- remifentanil-rocuroniume. Modified Yale Preoperative Anxiety Scale （mYPAS） score, sedation score, HR, mean arterial pressure （MAP）, respiratory rate （RR） and SpO2 were recorded before premedication （T1）, before separation from their parents （T2） and when entering the operating room （T3）; The incidence of sleep （ a sedation score of 4） was recorded at T2-3 . The end-tidal concentration of sevoflurane, infusion rate of remifentanil, laryngeal air way removal time, emergence time, duration of stay at the recovery room, incidence of delirium during recovery period, the percentage of patients requiring rescue analgesic, and adverse effects were also recorded. Results Compared to that at TI , the mYPAS score was significantly decreased at T2.3 , and the sedation score was significantly increased at Tz.3 in both groups （ P 〈 0.05）, HR at T2 and MAP at T2-3 were significantly decreased in group D, and HR at T3 was significantly increased in group M （P 〈 0.05）. Compared to group M, the sedation scores and the incidence of sleep were significantly increased at T2,3 , and the HR was significantly decreased at T2 in group D （ P 〈 0.05） . There was no significant difference in the mYPAS score, RR, MAP, SpO2 , end-tidal concentration of sevoflurane, infusion rate of remifentanil, laryngeal air way removal time, emergence time, duration of stay at the recovery room, incidence of delirium during recovery period, the percentage of patients requiring rescue analgesic, and incidence of adverse effects between D and M groups （P 〉 0.05）. Conclusion The sedative efficacy of iv dexmedetomidine is superior to that of iv midazolam when infused for premedication in children, but it exerts much influence on hemodynamics, and the changes in hemodynamics should be noted.