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目的比较右美托咪定与丙泊酚应用于患儿MRI检查镇静麻醉的有效性与安全性。方法将60例不配合MRI检查的患儿随机分为右美托咪定组(D组,n=30)和丙泊酚组(P组,n=30)。所有患儿入MRI准备室后予阿托品0.02 mg·kg~(-1),iv;氯胺酮1.0 mg·kg~(-1),iv。随后D组患儿予负荷量盐酸右美托咪定1μg·kg~(-1),iv gtt,15 min输注完毕;然后予1μg·kg~(-1)·h~(-1)的维持量至检查结束。P组患儿予负荷量丙泊酚1 mg·kg~(-1),iv;然后给予100μg·kg~(-1)·min~(-1)维持量至检查结束。记录2组患儿于入MRI准备室后(T0)、注射氯胺酮后1 min(T1)、右美托咪定及丙泊酚负荷量输注完毕即刻(T2)、输注维持量后15 min(T3)、检查结束时(T4)、苏醒即刻(T5)、离开复苏室即刻(T6)时记录血压、心率和SpO_2值,记录入睡时间、检查时间、复苏时间,以及呼吸抑制、术后躁动等不良反应的发生情况。结果 2组患儿均顺利完成MRI检查。P组患儿较D组入睡更快[(1.6±0.2)min vs(12.2±1.8)min,P<0.05],复苏时间更短[(47.4±6.3)min vs(54.1±9.1)min,P<0.05]。在面罩吸氧下,麻醉过程中P组患儿中有2例患儿出现短暂的呼吸抑制,SpO_2轻度下降,托起患儿下颌后即好转。D组患儿较P组患儿的心率下降更明显,但无心动过缓发生;P组患儿较D组患儿血压下降更明显,差异有统计学意义(P<0.05)。结论右美托咪定和丙泊酚均可为小儿MRI检查提供充分的麻醉。相比丙泊酚,右美托咪定组患儿入睡较慢,苏醒较慢,心率减低更明显,但更安全,血压稳定,无呼吸抑制发生。
Objective To compare the effectiveness and safety of dexmedetomidine and propofol applied to sedation anesthesia in MRI in children. Methods Sixty children without MRI were randomly divided into dexmedetomidine group (group D, n = 30) and propofol group (group P, n = 30). All patients received atropine 0.02 mg · kg -1 after iv in the MRI preparation room, iv, ketamine 1.0 mg · kg -1, iv. The children in group D were given dexmedetomidine dexmedetomidine 1μg · kg ~ (-1), iv gtt, 15 min infusion, and then to 1μg · kg -1 h -1 Maintain the amount until the end of the inspection. The patients in group P were given propofol 1 mg · kg ~ (-1) iv, and then the dose of 100 μg · kg -1 (-1) min was maintained until the end of the test. Two groups of children were recorded in the MRI preparation room (T0), 1 min after injection of ketamine (T1), dexmedetomidine and propofol loading immediately after infusion (T2), 15 min after infusion Blood pressure, heart rate and SpO_2 were recorded at T3, T4, T5 and T6. The time to fall asleep, the time of examination, the time of recovery, and respiratory depression and postoperative agitation were recorded Adverse reactions such as the occurrence of. Results The two groups of children successfully completed MRI examination. Compared with group D, patients in group P slept much faster than those in group D [(1.6 ± 0.2) min vs (12.2 ± 1.8) min, P <0.05], shorter recovery time [(47.4 ± 6.3) min vs (54.1 ± 9.1) min, P <0.05]. In the mask of oxygen, during anesthesia in two groups of children in group P there was a brief respiratory depression, SpO 2 decreased slightly, lifting the child after the improvement of the mandibular. The heart rate of children in group D was significantly lower than that of group P, but no bradycardia occurred. The blood pressure of children in group P was significantly lower than that of group D (P <0.05). Conclusion Both dexmedetomidine and propofol provide adequate anesthesia for MRI in children. Compared with propofol, dexmedetomidine children fell asleep more slowly, slower recovery, reduced heart rate more obvious, but more secure, stable blood pressure, no respiratory depression.