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目的:比较婴幼儿在机械通气镇静时使用右旋美托咪定和咪达唑仑效果。方法:收集我院2009年2月至2011年10月入住ICU需要机械通气且镇静时间大于24h的患儿60例,随机分为3组,每组20例,右旋美托咪啶1组(输注剂量为0.25μg.kg-1.h-1,D1组)、2组(输注剂量为0.5μg.kg-1.h-1,D2组)维持镇静,咪达唑仑组(输注剂量为0.05 mg.kg-1.h-1,M组)维持镇静。同时根据病情需要间断给予吗啡镇痛。镇静的疗效评估采用Ramsay镇静评分以及脑电双屏指数(BIS)评价。结果:60例患儿分为3组,每组20例,咪达唑仑组(M组)的输注持续时间(h)为22±8 h,0.25μg(D1组)和0.5μg(D2组)右旋美托咪啶组输注持续时间分别为21±10 h和22±9 h;M组的平均输注速率为0.22±0.05 mg.kg-1.h-1,D1组和D2组平均输注速率分别为0.28±0.07μg.kg-1.h-1和0.21±0.05μg.kg-1.h-1;三组差异无统计学意义。其中M组、D1组、D2组使用吗啡的剂量是分别为36 mg.kg-1.24h-1、29 mg.kg-1.24h-1和20mg.kg-.124h-1。D1组与M组使用吗啡的剂量差异无统计学意义。D2组与M组使用吗啡的剂量差异有统计学意义(P<0.05)。三组患儿BIS值和Ramsay评分监测差异无统计学意义。结论:右旋美托咪啶应用于婴幼儿是安全有效的,0.5μg.kg-1.h-1右旋美托咪啶组镇静更加有效,24小时吗啡的使用剂量显著减少。
PURPOSE: To compare the effects of dexmedetomidine and midazolam when infants and young children are mechanically ventilated and sedated. Methods: Sixty children with mechanical ventilation and sedation for more than 24 hours admitted to ICU from February 2009 to October 2011 in our hospital were randomly divided into 3 groups (n = 20 each), dexmedetomidine 1 The infusion dose was 0.25μg.kg-1.h-1, D1 group), two groups (0.5μg.kg-1.h-1 infusion group, D2 group) to maintain sedation, midazolam group Note the dose of 0.05 mg.kg-1.h-1, M group) to maintain sedation. At the same time according to the condition needs intermittent morphine analgesia. The sedation efficacy was evaluated using the Ramsay sedation score and the electroencephalogram double screen index (BIS). RESULTS: Sixty children were divided into three groups of 20 patients in each group. Infusion duration (h) was 22 ± 8 h in the midazolam group (group M) Group) were treated with dexmedetomidine for 21 ± 10 h and 22 ± 9 h, respectively. The average infusion rate in group M was 0.22 ± 0.05 mg.kg-1.h-1, The average infusion rate was 0.28 ± 0.07μg.kg-1.h-1 and 0.21 ± 0.05μg.kg-1.h-1 respectively. There was no significant difference among the three groups. The doses of morphine in groups M, D1 and D2 were 36 mg.kg-1.24 h-1, 29 mg.kg-1.24 h-1 and 20 mg.kg-.124 h-1, respectively. There was no significant difference in the dosage of morphine between D1 and M groups. There was significant difference in the dose of morphine between D2 group and M group (P <0.05). Three groups of children with BIS value and Ramsay score monitoring difference was not statistically significant. Conclusion: Dexmedetomidine is safe and effective for infants and young children. The sedation of dexmedetomidine in 0.5μg.kg-1.h-1 group was more effective and the dose of morphine reduced significantly in 24 hours.