盐酸右美托咪定联合咪达唑仑在儿童纤维支气管镜检查中的安全性和有效性——前瞻性随机对照研究

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study

摘要:

目的 探讨盐酸右美托咪定联合咪达唑仑在儿童纤维支气管镜（简称纤支镜）检查中的安全性和有效性。 方法 选取2018年9月至2021年2月拟行纤支镜检查的患儿118例为研究对象，采用随机数字表法将患儿分为对照组（n=60）和观察组（n=58）。观察组静脉泵注盐酸右美托咪定（1 μg/kg，浓度为2 μg/mL）后再静脉推注0.05 mg/kg咪达唑仑，10 min后以0.5~0.7 μg/(kg·h)静脉泵注盐酸右美托咪定维持麻醉。对照组静脉泵注丙泊酚（2 mg/kg）后静脉推注0.05 mg/kg咪达唑仑，10 min后以4~6 mg/(kg·h)静脉泵注丙泊酚维持麻醉。患儿失去意识后行纤支镜检查。分别在入镜前（T₀）、放镜时（T₁）、纤支镜到达声门（T₂）、纤支镜到达隆突（T₃）及进入支气管（T₄）各时间点记录患儿心率（heart rate，HR）、呼吸频率（respiratory rate，RR）、血氧饱和度（pulse oxygen saturation，SpO₂）和平均动脉压（mean arterial pressure，MAP）；并记录术中呼吸道峰压值（peak pressure，Ppeak）、检查时间、镇静程度、遗忘程度、不良反应发生情况及术后苏醒时间和术后躁动评分。 结果 观察组患儿在T₁~T₄期间MAP均较对照组显著降低，在T₁~T₃期间HR均较对照组显著降低（P<0.05）。对照组在T₁~T₄时MAP均较T₀时显著增加，观察组在T₃时MAP较T₀时显著增加（P<0.05）；对照组在T₁~T₃时HR均较T₀时显著增加（P<0.05）。观察组术中Ppeak值、术中不良反应发生率及术后躁动评分均显著低于对照组，检查时间短于对照组，术后遗忘率及麻醉优良率显著高于对照组（P<0.05），但术中镇静程度及术后苏醒时间比较，差异无统计学意义（P>0.05）。 结论 盐酸右美托咪定联合咪达唑仑全身麻醉可用于患儿纤支镜检查，检查过程中患儿生命体征稳定，并能有效减少术中不良反应及术后躁动的发生，缩短检查时间，提高对检查过程中不适方面的遗忘率，安全有效。

Abstract:

Objective To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children. Methods A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (n=60) and an observation group (n=58) using a random number table. The observation group received intravenous pumping of dexmedetomidine hydrochloride (2 μg/mL) at 1 μg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7 μg/(kg·h) 10 minutes later to maintain anesthesia. The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by propofol pumped intravenously at 4-6 mg/(kg·h) 10 minutes later to maintain anesthesia. Fiberoptic bronchoscopy was performed after the children were unconscious. Heart rate (HR), respiratory rate, blood oxygen saturation, and mean arterial pressure (MAP) were recorded before inserting the bronchoscope (T0), at the time of inserting the bronchoscope (T1), when the bronchoscope reached the glottis (T2), when the bronchoscope reached the carina (T3), and when the bronchoscope entered the bronchus (T4). The intraoperative peak airway pressure (Ppeak), examination time, degree of sedation, extent of amnesia, incidence of adverse reactions, postoperative awakening time, and postoperative agitation score were also recorded. Results Compared with the control group, the observation group had significantly decreased MAP at T1 to T4 and HR at T1 to T3 (P<0.05). Compared with that at T0, MAP was significantly increased at T1 to T4 in the control group and at T3 in the observation group (P<0.05). HR was significantly higher at T1 to T3 than at T0 (P<0.05). Compared with the control group, the observation group showed significantly lower intraoperative Ppeak value, incidence of intraoperative adverse reactions, and postoperative agitation score, significantly shorter examination time, and better effects of amnesia and anesthesia (P<0.05). There was no significant difference in the degree of intraoperative sedation and postoperative awakening time between the two groups (P>0.05). Conclusions Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.