水合氯醛与咪达唑仑对磁共振检查首次镇静失败幼儿的补救效果比较

Comparison of remedial effects of chloral hydrate and midazolam on children with first sedation failure by magnetic resonance imaging

目的探讨1~3岁幼儿水合氯醛首次镇静失败后4h再次应用水合氯醛或咪达唑仑的补救镇静效果。方法选取首都儿科研究所附属儿童医院神经内科病房2021年1—8月收治的年龄1~3岁拟做磁共振成像(magnetic resonance imaging,MRI)检查,经水合氯醛首次镇静失败患儿104例。应用随机数字表法分为水合氯醛组和咪达唑仑组,每组各52例。水合氯醛组于镇静失败4h后追加10%水合氯醛50mg/kg口服,咪达唑仑组追加咪达唑仑0.2~0.3mg/kg静脉推注。比较两组患儿补救镇静成功率、补救镇静成功后患儿入睡时间、苏醒时间、不良反应及MRI检查时间。结果水合氯醛组口服药物后严重呕吐退出研究1例,镇静失败3例,最终共48例患儿纳入研究;咪达唑仑组镇静失败1例,最终共51例患儿纳入研究。两组给药后补救镇静成功率及不良反应发生率比较差异无显著性(P>0.05)。咪达唑仑组患儿入睡时间和苏醒时间均短于水合氯醛组,差异有显著性(P<0.05)。两组患儿MRI检查时间比较差异无显著性(P>0.05)。结论对于1~3岁行MRI检查的幼儿,水合氯醛首次镇静失败后应用咪达唑仑补救镇静,入睡时间及苏醒时间均短于应用水合氯醛补救镇静,两种补救镇静方法镇静成功率及不良反应发生率差异无显著性。

Objective To explore the comparison of remedial sedation effect of chloral hydrate or midazolam applied again 4 hours after the first sedation failure of chloral hydrate in children aged 1-3 years.Method From January 2021 to August 2021,104 children aged 1-3 years who planned to undergo magnetic resonance imaging(MRI)in the Department of Neurology of our hospital were selected.The patients were randomly divided into chloral hydrate group and midazolam group,with 52 cases in each group.Chloral hydrate group add 10%chloral hydrate 50mg/kg orally,midazolam group add midazolam 0.2-0.3mg/kg intravenously 4 hours after sedation failure.The success rate of rescue sedation,sleep time,recovery time and adverse reactions were recorded.Result There was no significant difference in the success rate and adverse reaction rate of remedial sedation between chloral hydrate group and midazolam group(P>0.05).The sleep time of midazolam group was shorter than that of chloral hydrate group(P<0.05),and the recovery time of midazolam group was shorter than that of chloral hydrate group(P<0.05).There was no significant difference in MRI examination time between the two groups(P>0.05).Conclusion For children aged 1-3 years,the sleep time of midazolam intravenous injection after the first sedation failure of chloral hydrate is shorter than that of chloral hydrate group,and the recovery time of midazolam group is shorter than that of chloral hydrate group.