咪达唑仑联合右美托咪定用于儿童MRI检查镇静

The use of midazolam combined with dexmedetomidine for MRI sedation in children

目的 评价咪达唑仑联合右美托咪定用于儿童磁共振成像(magnetic resonance imaging,MRI)检查镇静的有效性及安全性。方法 收集2021年8月至2022年7月在山东大学附属儿童医院镇静中心接受镇静行MRI检查的3773例患儿的病历资料。根据年龄将其分为婴儿组(年龄≤1岁,922例)、幼儿组(1岁<年龄≤3岁,1153例)和儿童组(3岁<年龄≤8岁,1698例)。镇静方案为咪达唑仑0.5mg/kg口服联合右美托咪定2μg/kg滴鼻,MRI检查前30min用药,使用Ramsay镇静量表评估镇静深度,评分≥5分视为达到深度镇静。统计并分析各年龄组患儿的一般资料、镇静成功率、入睡时间、苏醒时间及不良反应的发生情况。结果 共纳入分析患儿3773例,镇静成功3480例,总成功率92.2%。儿童组患儿的15min和30min镇静成功率显著低于婴儿组和幼儿组(P<0.05);幼儿组患儿的45min和60min镇静成功率显著低于婴儿组和儿童组(P<0.05);儿童组患儿的入睡时间显著长于婴儿组和幼儿组(P<0.001);婴儿组患儿的苏醒时间显著长于幼儿组和儿童组(P<0.001)。总不良反应发生率为4.9%,儿童组患儿的总不良反应发生率显著低于婴儿组和幼儿组(P<0.001)。结论 口服咪达唑仑联合右美托咪定滴鼻可安全有效地用于8岁以下儿童的MRI检查镇静。年龄越小镇静成功率越高,苏醒时间越长,但总体不良反应发生率低,不失为儿童MRI检查镇静的一个安全有效的联合用药方案。

Objective To evaluate the efficacy and safety of midazolam combined with dexmedetomidine for sedation during magnetic resonance imaging(MRI)examination in children.Methods The medical records of children who underwent sedated MRI examinations at the Sedation Center of Children’s Hospital Affiliated to Shandong University from August 2021 to July 2022 were collected.The patients were divided into three groups based on age:Infant group(age≤1 year old,922 cases),toddler group(1 year old<age≤3 years old,1153 cases),and child group(3 years old<age≤8 years old,1698 cases).The sedation regimen was oral midazolam solution 0.5mg/kg combined with intranasal dexmedetomidine 2μg/kg.Medication taken 30 minutes prior to MRI examination.The sedation depth was evaluated using the Ramsay sedation scale.A score of≥5 points was considered to achieve deep sedation.The general data,sedation success rate,sleep time,wake time and the occurrence of adverse reactions were analyzed.Results The total number of children included in the analysis amounted to 3773,with 3480 cases successfully sedated,with a total success rate of 92.2%.The success rate of 15min and 30min sedation in child group was significantly lower than that in infant group and toddler group(P<0.05).The success rate of 45min and 60min sedation in toddler group was significantly lower than that in infant group and child group(P<0.05).The sleep time in child group was significantly longer than that in infant group and toddler group(P<0.001).The recovery time of infant group was longer than that of toddler group and child group(P<0.001).The overall incidence of adverse reactions was 4.9%.The incidence of total adverse reactions in child group was significantly lower than that in infant group and toddlers group(P<0.001).Conclusion Oral midazolam combined with intranasal dexmedetomidine is safe and effective for sedation during MRI examinations in children.The younger the age,the higher the sedation success rate,the longer the recovery time,but the overall incidence of adverse reactions is low.This combination of drugs is a safe and effective sedation option for pediatric MRI examinations.