右美托咪定及其分别复合氯胺酮、咪达唑仑滴鼻用于患儿术前镇静比较研究
|
摘要
目的:比较右美托咪定单独或分别复合咪达唑仑、氯胺酮作为儿童术前用药的镇静效果及安全性。方法:选择美国麻醉医师协会(ASA)Ⅰ～Ⅱ级行择期手术患儿75例,年龄2～12岁,随机分为右美托咪啶组(D组)、右美托咪定复合咪达唑仑组(DM组)和右美托咪定复合氯胺酮组(DK组)。术前30 min右美托咪啶1μg/kg、右美托咪啶1μg/kg+咪达唑仑0. 2 mg/kg和右美托咪定1μg/kg+氯胺酮3 mg/kg分别滴鼻给药,观察给药前(T0),给药后5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、25 min(T5)、30 min(T6)时患儿的心率(HR)、收缩压(SBP)、舒张压(DBP)、呼吸频率(RR)、氧饱和度(Sp O2)和Ramsay镇静评分。结果:与D组比较,DK和DM组T1～T6时心率降低(P<0. 05);与D组、DK组比较,DM组T1～T6时收缩压降低(P<0. 05);与D组、DK组比较,DM组T1～T6时舒张压降低(P<0. 05)。与D组比较,DK组和DM组T1～T6时镇静评分升高(P<0. 05);与DM组比较,DK组T2～T6时镇静评分降低(P<0. 05),无镇静过度。结论:在小儿麻醉前给予右美托咪定1μg/kg+氯胺酮3mg/kg滴鼻可以产生良好的镇静效果且无滴鼻刺激性。
Objective: To compare the preoperative sedative effects and safety of dexmedetomidine respectively combined with ketamine and midazolam for preoperative sedation in children. Methods: Seventy-five children aged 2-12 years undergoing elective surgery from the American Society of Anesthesiologists(ASA) Ⅰ ～ Ⅱ were randomly divided into the dexmedetomidine group(group D),dexmedetomidine combined with midazolam group(group DM) and dexmedetomidine combined with ketamine group(group DK).Dexmedetomidine 1 g/kg,dexmedetomidine 1 g/kg+midazolam 0. 2 mg/kg and dexmedetomidine 1 g/kg+ketamine 3 mg/kg were given by intranasal administration respectively 30 min before surgery. The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),respiratory rate(RR),oxygen saturation(Sp O2) and Ramsay sedation score were observed before administration(T0) and after administration of 5 min(T1),10 min(T2),15 min(T3),20 min(T4),25 min(T5) and 30 min(T6). Results:Compared with group D,the HR decreased in group DK and group DM at T1-T6(P<0. 05). Compared with group D and group DK,the SBP decreased in group DM at T1-T6(P<0. 05). Compared with group D and group DK,the DBP decreased in group DM at T1-T6(P<0. 05). Compared with group D,the sedation score increased in group DK and group DM at T1-T6(P<0. 05). Compared with group DM,the sedation score decreased in group DK at T2-T6(P < 0. 05),and there was no excessive sedative effects. Conclusion:Dexmedetomidine 1 μg/kg + ketamine 3 mg/kg in intranasal administration before pediatric anesthesia produces a good sedative effect without any nasal irritation.
Objective: To compare the preoperative sedative effects and safety of dexmedetomidine respectively combined with ketamine and midazolam for preoperative sedation in children. Methods: Seventy-five children aged 2-12 years undergoing elective surgery from the American Society of Anesthesiologists(ASA) Ⅰ ～ Ⅱ were randomly divided into the dexmedetomidine group(group D),dexmedetomidine combined with midazolam group(group DM) and dexmedetomidine combined with ketamine group(group DK).Dexmedetomidine 1 g/kg,dexmedetomidine 1 g/kg+midazolam 0. 2 mg/kg and dexmedetomidine 1 g/kg+ketamine 3 mg/kg were given by intranasal administration respectively 30 min before surgery. The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),respiratory rate(RR),oxygen saturation(Sp O2) and Ramsay sedation score were observed before administration(T0) and after administration of 5 min(T1),10 min(T2),15 min(T3),20 min(T4),25 min(T5) and 30 min(T6). Results:Compared with group D,the HR decreased in group DK and group DM at T1-T6(P<0. 05). Compared with group D and group DK,the SBP decreased in group DM at T1-T6(P<0. 05). Compared with group D and group DK,the DBP decreased in group DM at T1-T6(P<0. 05). Compared with group D,the sedation score increased in group DK and group DM at T1-T6(P<0. 05). Compared with group DM,the sedation score decreased in group DK at T2-T6(P < 0. 05),and there was no excessive sedative effects. Conclusion:Dexmedetomidine 1 μg/kg + ketamine 3 mg/kg in intranasal administration before pediatric anesthesia produces a good sedative effect without any nasal irritation.
引文
[1]李秀泽,李卫,夏氢,等.氯胺酮与喉罩-七氟醚全麻在小儿斜疝手术中应用的对比研究[J].实用医学杂志,2010,26(18):3418-3419.
[2]MALHOTRA P U,THAKUR S,SINGHAL P,et al.Comparative evaluation of dexmedetomidine and midazolamketamine combination as sedative agents in pediatric dentistry:A double-blinded randomized controlled trial[J].Contemporary clinical dentistry,2016,7(2):186-192.
[3]YUEN V M,IRWIN M G,HUI T W,et al.A double-blind,crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine[J].Anesth Analg,2007,105(2):374-380.
[4]YUEN V M,HUI T W,IRWIN M G,et al.Optimal timing for the administration of intranasal dexmedetomidine for premedication in children[J].Anaesthesia,2010,65(9):922-929.
[5]刘俊锋.右美托咪定滴鼻用于小儿CT/MRI检查时的镇静的可行性.中国实用医药,2014,9(16):30-31.
[6]ALMENRADER N,PASSARIELLO M,COCCETTI B,et al.Premedication in children:A comparison of oral midazolam and oral clonidine[J].Pediatr Anesth,2007,17(12):1143-1149.
[7]BAHETWAR S K,PANDEY R K,SAKSENA A K,et al.Acomparative evaluation of intranasal midazolam,ketamine and their combination for sedation of young uncooperative pediatric dental patients:A triple blind randomized crossover trial[J].JClin Pediatr Dent,2011,35(4):415-420.
[8]FUKUTA O,BRAHAM R L,YANASE H,et al.Intranasal administration of midazolam:Pharmacokinetic and pharmacodynamic properties and sedative potential[J].ASDC J Dent Child,1997,64(2):89-98.
[9]OTSUKA Y,YUSA T,HIGA M,et al.Intranasal midazolam for sedation before anesthesia in pediatric patients[J].Masui,1994,43(1):106-110.
[10]DANILO B,GIOVANNI B,PIERO V,et al.Utility of intranasal ketamine and midazolam to perform gastric aspirates in children:A double-blind,placebo controlled,randomized study[J].BMCPediatrics,2014,14(1):67-74.
[11]NARENDRA P L,RAMESH N W,SAMSON N,et al.Acomparison of intranasal ketamine and intranasal midazolam for pediatric premedication[J].Anesthesia:essays and researches,2015,9(2):213-218.
[12]NATARAJAN S M,KUMAR P R,KUMAR S A,et al.Acomparative evaluation of intranasal dexmedetomidine,midazolam and ketamine for their sedative and analgesic properties:A triple blind randomized study[J].J Clin Pediatr Dent,2014,38(3):255-261.
[11]RAVI B,SANTHOSH M C B,VENKATESH M A,et al.Comparison of intranasal dexmedetomidine and dexmedetomidineketamine for premedication in pediatrics patients:Arandomized double-blind study[J].Anesthesia:essays and researches,2016,10(2):349-355.
[12]王甲高,李银萍,冉然,等.右美托咪定联合咪达唑仑术前滴鼻在小儿斜疝手术麻醉中的应用[J].湖北医药学院学报,2014,33(1):21-24.
[13]陈文华,陈铭君,陈志强,等.不同剂量右美托咪定滴鼻用于小儿无痛纤维结肠镜检查术的临床效果[J].江西医药,2014,51(4):366-368.
[14]白波.右美托咪定联合咪达唑仑术前滴鼻在小儿斜疝手术麻醉中的应用效果评价[J].中国医药指南,2017,15(7):83-84.
[15]BHAT R,SANTHOSH M C,ANNIGERI V M,et al.Comparison of intranasal dexmedetomidine anddexmedetomidineketamine for premedication inpediatrics patients:A randomized double-blind study[J].Anesthesia:essays and researches,2016,10(2):349-355.
[16]BUONSENSO D,BARONE G,VALENTINI P,et al.Utility of intranasal Ketamine and Midazolam to perform gastric aspirates in children:A double-blind,placebo controlled,randomized study children:A double-blind,placebo controlled,randomized study[J].BMC Pediatric,2014,14:67.doi:10.1186/1471-2431-14-67.
[17]KUMAR L,KUMAR A,PANIKKAVEETIL R,et al.Efficacy of intranasal dexmedetomidine versus oral midazolam for paediatric premedication[J].Indian J Anaesth,2017,61(2):125-130.
[18]贾继娥,陈佳瑶,胡潇,等.氯胺酮复合或不复合右美托咪定作为白内障患儿术前用药的对比分析[J].复旦学报,2013,40(3):363-366.
[19]陈虹光,周瑞仁.右美托咪定用于小儿术前镇静的研究进展[J].儿科药学杂志,2017,23(12):60-63.
[20]NISHAT M D,DAVID W A,WAGNER B K,et al.Comparison of intranasal midazolam and sufentanil premedication in pediatric outpatients[J].Clinical trials and therapeutics,1996,59(3):341-348.
[21]HELEN W K,JAMES L R.Transmucosal administration of midazolam for premedication of pediatric patients[J].Anesthesiology,1993,78(5):885-891.
[22]陈金仙,顾晓霞,张良清.右美托咪定滴鼻预处理减少患儿依托咪酯复合氯胺酮麻醉不良反应的临床效果[J].临床麻醉学杂志,2013,29(8):799-801.(编辑:杨丹)
[2]MALHOTRA P U,THAKUR S,SINGHAL P,et al.Comparative evaluation of dexmedetomidine and midazolamketamine combination as sedative agents in pediatric dentistry:A double-blinded randomized controlled trial[J].Contemporary clinical dentistry,2016,7(2):186-192.
[3]YUEN V M,IRWIN M G,HUI T W,et al.A double-blind,crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine[J].Anesth Analg,2007,105(2):374-380.
[4]YUEN V M,HUI T W,IRWIN M G,et al.Optimal timing for the administration of intranasal dexmedetomidine for premedication in children[J].Anaesthesia,2010,65(9):922-929.
[5]刘俊锋.右美托咪定滴鼻用于小儿CT/MRI检查时的镇静的可行性.中国实用医药,2014,9(16):30-31.
[6]ALMENRADER N,PASSARIELLO M,COCCETTI B,et al.Premedication in children:A comparison of oral midazolam and oral clonidine[J].Pediatr Anesth,2007,17(12):1143-1149.
[7]BAHETWAR S K,PANDEY R K,SAKSENA A K,et al.Acomparative evaluation of intranasal midazolam,ketamine and their combination for sedation of young uncooperative pediatric dental patients:A triple blind randomized crossover trial[J].JClin Pediatr Dent,2011,35(4):415-420.
[8]FUKUTA O,BRAHAM R L,YANASE H,et al.Intranasal administration of midazolam:Pharmacokinetic and pharmacodynamic properties and sedative potential[J].ASDC J Dent Child,1997,64(2):89-98.
[9]OTSUKA Y,YUSA T,HIGA M,et al.Intranasal midazolam for sedation before anesthesia in pediatric patients[J].Masui,1994,43(1):106-110.
[10]DANILO B,GIOVANNI B,PIERO V,et al.Utility of intranasal ketamine and midazolam to perform gastric aspirates in children:A double-blind,placebo controlled,randomized study[J].BMCPediatrics,2014,14(1):67-74.
[11]NARENDRA P L,RAMESH N W,SAMSON N,et al.Acomparison of intranasal ketamine and intranasal midazolam for pediatric premedication[J].Anesthesia:essays and researches,2015,9(2):213-218.
[12]NATARAJAN S M,KUMAR P R,KUMAR S A,et al.Acomparative evaluation of intranasal dexmedetomidine,midazolam and ketamine for their sedative and analgesic properties:A triple blind randomized study[J].J Clin Pediatr Dent,2014,38(3):255-261.
[11]RAVI B,SANTHOSH M C B,VENKATESH M A,et al.Comparison of intranasal dexmedetomidine and dexmedetomidineketamine for premedication in pediatrics patients:Arandomized double-blind study[J].Anesthesia:essays and researches,2016,10(2):349-355.
[12]王甲高,李银萍,冉然,等.右美托咪定联合咪达唑仑术前滴鼻在小儿斜疝手术麻醉中的应用[J].湖北医药学院学报,2014,33(1):21-24.
[13]陈文华,陈铭君,陈志强,等.不同剂量右美托咪定滴鼻用于小儿无痛纤维结肠镜检查术的临床效果[J].江西医药,2014,51(4):366-368.
[14]白波.右美托咪定联合咪达唑仑术前滴鼻在小儿斜疝手术麻醉中的应用效果评价[J].中国医药指南,2017,15(7):83-84.
[15]BHAT R,SANTHOSH M C,ANNIGERI V M,et al.Comparison of intranasal dexmedetomidine anddexmedetomidineketamine for premedication inpediatrics patients:A randomized double-blind study[J].Anesthesia:essays and researches,2016,10(2):349-355.
[16]BUONSENSO D,BARONE G,VALENTINI P,et al.Utility of intranasal Ketamine and Midazolam to perform gastric aspirates in children:A double-blind,placebo controlled,randomized study children:A double-blind,placebo controlled,randomized study[J].BMC Pediatric,2014,14:67.doi:10.1186/1471-2431-14-67.
[17]KUMAR L,KUMAR A,PANIKKAVEETIL R,et al.Efficacy of intranasal dexmedetomidine versus oral midazolam for paediatric premedication[J].Indian J Anaesth,2017,61(2):125-130.
[18]贾继娥,陈佳瑶,胡潇,等.氯胺酮复合或不复合右美托咪定作为白内障患儿术前用药的对比分析[J].复旦学报,2013,40(3):363-366.
[19]陈虹光,周瑞仁.右美托咪定用于小儿术前镇静的研究进展[J].儿科药学杂志,2017,23(12):60-63.
[20]NISHAT M D,DAVID W A,WAGNER B K,et al.Comparison of intranasal midazolam and sufentanil premedication in pediatric outpatients[J].Clinical trials and therapeutics,1996,59(3):341-348.
[21]HELEN W K,JAMES L R.Transmucosal administration of midazolam for premedication of pediatric patients[J].Anesthesiology,1993,78(5):885-891.
[22]陈金仙,顾晓霞,张良清.右美托咪定滴鼻预处理减少患儿依托咪酯复合氯胺酮麻醉不良反应的临床效果[J].临床麻醉学杂志,2013,29(8):799-801.(编辑:杨丹)