论文部分内容阅读
目的:观察经鼻给予右美托咪定（dexmedetomidine, Dex）复合小剂量丙泊酚静脉推注应用于小儿两部位MRI检查的安全性和有效性。方法:60例ASA分级Ⅰ、Ⅱ级择期行两个部位（中途需搬动患儿1次，时间>45 min）MRI检查的儿童，按照随机数字表法分为两组（每组30例）：右美托咪定2 μg/kg组（D2组）和右美托咪定3 μg/kg组（D3组）。MRI检查前20 min用注射器经鼻给予D2组患儿Dex（原液）2 μg/kg，D3组给予3 μg/kg。诱导时所有患儿均采用小剂量分次给药的方法给予丙泊酚，每次1 mg/kg，直至达到入室镇静标准（Ramsay镇静评分5~6分）。记录并观察所有患儿给予Dex前（Tn 0）、给予Dex 10 min（Tn 1）、给予Dex 20 min（Tn 2）、诱导毕（Tn 3）、检查中（Tn 4）、检查毕（Tn 5）、苏醒时（Tn 6）的生命体征变化及诱导和检查过程中不良反应（体动、呼吸抑制、SpOn 2下降等）的发生情况；记录检查过程中两组患儿丙泊酚的使用情况及检查时间、苏醒时间等，观察并记录苏醒期躁动等并发症发生情况。n 结果:两组患儿MAP和SpOn 2各时点差异均无统计学意义（n P>0.05）；与Tn 0时比较，两组患儿Tn 3时心率均明显减慢（n P=0.01），其余各时点心率差异无统计学意义（n P>0.05）。检查过程中D3组无患儿出现体动，D2组有7例患儿出现体动（n P0.05）。两组患儿检查时间差异无统计学意义（n P>0.05），苏醒时间D3组明显长于D2组（n P=0.01），苏醒期躁动发生率两组均为10%。n 结论:3 μg/kg Dex在小儿两部位MRI检查前20 min经鼻滴注复合小剂量丙泊酚静脉推注可明显减少检查中体动的发生，提高此类检查效率，具有较高的安全性和舒适性。“,”Objective:To observe the safety and effectiveness of dexmedetomidine (Dex) (nasal administration) combined with a small-dose propofol (intravenous infusion) for children undergoing two-position magnetic resonance imaging (MRI).Methods:A total of 60 children, American Society of Anesthesiologists (ASA) grades Ⅰ or Ⅱ, who were scheduled for two-position MRI examination (where the patients required to be moved once within more than 45 min) were enrolled. According to the random number table method, the patients were divided into two groups (n n=30): a 2 μg/kg Dex (D2) group and a 3 μg/kg Dex (D3) group. Then, 20 min before MRI examination, patients in the D2 and D3 groups were nasally administered with Dex at 2 μg/kg and 3 μg/kg, respectively. During anesthesia induction, all the patients were administered with propofol at 1 mg/kg once, until Ramsay scores 5-6 were achieved. The changes in vital signs before Dex administration (T n 0), 10 min after administration (Tn 1), 20 min after administration (Tn 2), after induction (Tn 3), during examination (Tn 4), after examination (Tn 5), and on awakening (Tn 6) and adverse reactions such as body movement, respiratory depression, decreased pulse oxygen saturation (SpOn 2) were recorded. The dosage of propofol, examination time and the awakening time were recorded and agitation during the recovery period and other complications were observed.n Results:There was no significant difference in mean arterial pressure (MAP) and SpOn 2 at all the time points between the two groups (n P>0.05). Compared with those at Tn 0, patients in both groups presented remarkably decreased heart rate at Tn 3 (n P=0.01), without statistical difference in heart rate at other time points. During examination, no children moved in the D3 group, while seven children moved in the D2 groups, without other adverse reactions in both groups (n P0.05). While there was no statistical difference in examination time between the two groups, the D3 group presented remarkably longer recovery time than the D2 group (n P=0.01). The incidence of agitation during the recovery period was 10% for both groups.n Conclusions:Intranasal administration of 3 μg/kg Dex plus intravenous infusion of a small-dose propofol for children 20 min before two-position NRI can obviously reduce the occurrence of body movement and improve examination efficiency, with high safety and comfort.