不同给药途径的右美托咪定用于小儿磁共振检查的临床观察

The clinic effect of dexmedetomidine given by different administration route for pediatric MRI sedation

目的探讨小儿磁共振（magnetic resonance imaging,MRI）检查中右美托咪定（dexmedetomidine,DEX）不同给药途径的镇静效应和安全性。方法选取180例在我院实施MRI检查的患儿,ASAⅠ~Ⅱ级,年龄2~8岁,采用随机数字表法分为鼻内滴注组（DN组,n=60）、肌肉注射组（DM组,n=60）、静脉注射组（DV组,n=60）,分别采用鼻内滴注、肌肉注射、静脉注射的方法注入2μg/kg DEX。记录生命体征变化、不良事件发生率、入睡时间、苏醒时间、镇静失败率。结果镇静失败率DM组为8.3%,DN组为5.0%,DV组最高为13.3%;检查医师满意度DN组及DM组明显高于DV组（P〈0.01）;DV组的血压、心率下降较DM及DN组明显（P〈0.05）;术中心动过缓发生率,DV组较DM、DN组高（P〈0.05）;需要应用麻黄碱例数DV组较DM、DN组多（P〈0.05）;DV组入睡最早（P〈0.01）,DM组和DN组之间无明显差异（P〉0.05）;在苏醒时间上,DV组较DM、DN组短（P〈0.01）,DN组较DM组短（P〈0.05）。结论在小儿MRI检查中,鼻内滴注和肌肉注射DEX虽然镇静的入睡时间慢于静脉注射组,但在维持生命体征稳定、术中不良事件的发生率及镇静的成功率上要优于静脉注射。鼻内滴注方式为无创性,小儿更易于接受。

Objective To compare the sedate efficacy and safety of dexmedetomidine （DEX） given by intranasal, intra- muscular and introvenous for pediatric MRI sedation. Methods One hundred and eighty children between the age of 2 and 8 years with ASA physical status Ⅰ-Ⅱ scheduled for magnetic resonance imaging （MRI） were randomly assigned to three groups. Group DN （n=60）, received intranasal dexmedetomidine 2μg/kg. Group DM （n=60） received intramuscular dexmedetomidine 2μg/kg. Group DV （n=60） received 2μg/kg dexmedetomidine introvenously. Vital sign, adverse events rates, time to sedation, recovery time and failed sedation rates were recorded. Results Compared to DM group（8.3%）and DN group（5.0%）, the sedation failure rate of DV group （13.3%） was the highest. The technician＇s satisfaction of DN group was highest among three groups （P〈0.01）. Patients in DV group had lower MBP,HR compared to patients in other two groups （P〈0.05）. The patients in DV group had the shortest time to sedation（P〈0.01）. The recovery time in DV group was the shortest （P〈0.01）, and was shorter in DN group in comparison to DM group （P〈0.05）. The bradycardia and using ephedrine rates were higher in DV group in com- parison with the others（P〈0.05）. Conclusion In pediatric MRI sedation, DV dexmedetomidine had a fastest sedation onset, but DM and DN dexmedetomidine had more stable vital sign, lower adverse event rates and higher sedation successful rates. In the comparison to DM procedure, DN is more acceptant in children for being noninvasive.