国际麻醉学与复苏杂志   2016, Issue (1): 2-2
    
右美托咪定滴鼻用于患儿面罩吸入麻醉诱导前镇静的半数有效量
纪宏新, 何世琼, 毕莹, 陈文, 李安学1()
1.深圳市龙岗区人民医院麻醉科
The median effective dose of intranasal dexmedetomidine sedation for acceptance of mask inhalation anesthesia induction in children
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摘要:

目的 测定右美托咪定(dexmedetomidine, Dex)滴鼻用于患儿面罩吸入麻醉诱导前镇静的ED50,比较幼儿、学龄前和学龄患儿ED50的差异。 方法 选择ASA分级Ⅰ、Ⅱ级接受面罩吸入麻醉诱导的患儿,按年龄分为幼儿组(1~3岁)、学龄前组(4~6岁)和学龄组(7~12岁),每组预计35例。每组均在麻醉前1 h经鼻滴入Dex,起始剂量为2 μg/kg,按改良序贯法进行调整,根据上一例患儿面罩吸入诱导时的镇静满意程度,下一例患儿增加或减少0.25 μg/kg。镇静效果以面罩接受程度四分法进行评估,1~2分为镇静不满意,3~4分为镇静满意。用概率单位回归分析法计算出Dex满意镇静的ED50及相应的95%置信区间(95%CI)。 结果 幼儿组、学龄前组和学龄组实际所需例数分别为31、28和30。幼儿组、学龄前组和学龄组Dex滴鼻镇静的ED50和95%CI分别为1.94(1.72~2.18)、1.61(1.41~1.82) μg/kg和1.30(1.13~1.47) μg/kg,3组间比较,差异有统计学意义(P<0.05)。 结论 随着患儿年龄的增加,面罩吸入麻醉诱导前所需Dex滴鼻镇静的ED50减小。

关键词: 右美托咪定; 鼻腔给药; 吸入诱导; 小儿; 镇静; 半数有效量
Abstract:

Objective To determine the ED50 of intranasal dexmedetomidine(Dex) sedation for acceptance of mask inhalation anesthesia induction in children, and to compare the difference of ED50 among infants, preschool and school-age children. Methods ASA physical status Ⅰor Ⅱ children, scheduled for mask inhalation anesthesia induction, were allocated into 3 groups according to age: infant group(1-3 y), preschool group(4-6 y) and school-age group(7-12 y), and the case number expectation for each group is 35. Every child was titrated Dex into nostril 1 h before inhalational induction, and the initial dose of Dex was set at 2 μg/kg. Using the modified Dixon's up-and-down method depending on the sedation effect of the previous child, the dose of Dex in the next child was increased or decreased by 0.25 μg/kg. The tolerant degree of face mask was evaluated using a different 4?蛳point scale. 1-2 scores were considered as unsatisfactory and 3-4 scores were considered as satisfactory. Probit analysis was used for calculating ED50 and 95% confidence interval (CI) of intranasal Dex sedation. Results 31, 28 and 30 cases were practically used in infant group, preschool group and school-age group, respectively. The ED50 of Dex for intranasal sedation was 1.94 μg/kg in infant group (95%CI: 1.72-2.18 μg/kg), 1.61 μg/kg in preschool group (95%CI: 1.41-1.82 μg/kg), and 1.30 μg/kg in school-age group (95%CI: 1.13-1.47 μg/kg), respectively. The ED50 among the three groups have significant difference(P<0.05). Conclusions The ED50 of Dex required for intranasal sedation before mask inhalation anesthesia induction is decreased followed by the increase of age in children.

Key words: Dexmendetomidine; Intranasal administration; Inhalational induction; Children; Sedation; Median effective dose