水合氯醛联合右美托咪定对不同年龄儿童无创检查的镇静效果分析

Sedative effect of chloral hydrate combined with dexmedetomidine in non-invasive examinations for children of different ages

摘要:

目的 探讨水合氯醛联合右美托咪定在不同年龄儿童无创检查中的镇静效果及安全性，为临床不同年龄段儿童无创检查时选择镇静方案提供参考。方法 回顾性分析2024年1月—12月在新疆医科大学第一附属医院接受无创检查的1 222例儿童的临床资料。按照年龄将患儿分为4组，其中新生儿组（0～28 d）6例、婴儿组（29 d～1岁）349例、幼儿组（1～3岁）714例、儿童组（4～13岁）153例。患儿均采用水合氯醛联合右美托咪定进行镇静，比较4组患儿的临床镇静指标（镇静起效时间、磁共振成像检查时间、苏醒时间）、手术麻醉前（T₀）至给药30 min（T₂）时的心率（HR），并统计镇静一次性成功率及镇静相关不良事件发生情况。结果 各组MRI检查时间比较，差异无统计学意义（P 0.05）。各组镇静起效时间、苏醒时间比较，差异均有统计学意义（P 0.05）。各组T₀、T₁、T₂的HR比较，结果 ①不同时间点HR比较，差异有统计学意义（P 0.05）；②各组HR比较，差异有统计学意义（P 0.05），儿童组HR水平较低，相对更平缓；③各组HR变化趋势比较，差异有统计学意义（P 0.05）。各组一次性成功率比较，差异有统计学意义（P 0.05）。各组不良反应总发生率比较，差异无统计学意义（P 0.05）。结论 水合氯醛联合右美托咪定用于不同年龄儿童无创检查的镇静效果可靠，能有效维持患儿应激水平稳定，且不良反应率低，其中新生儿组镇静起效更快、幼儿组苏醒更迅速，临床可根据儿童年龄特点合理应用。

Abstract:

Objective To explore the sedative effect and safety of chloral hydrate (CH) combined with dexmedetomidine (Dex) in non-invasive examinations for children of different ages, and to provide a clinical reference for sedation regimen selection.Methods Clinical data of 1222 children undergoing non-invasive examinations in our hospital from January 2024 to December 2024 were retrospectively analyzed. They were divided into 4 age groups: the neonatal group (0 to 28 days) with 6 cases, the infant group (29 days to 1 year) with 349 cases, the toddler group (1 to 3 years) with 714 cases, and the child group (4 to 13 years) with 153 cases. All received CH and Dex for sedation. The clinical sedation indicators among the four groups of children were compared, including onset time of sedation, duration of MRI examination, and recovery time. Heart rate (HR) was recorded from the pre-anesthesia baseline (T₀) to 30 minutes after administration (T₂). In addition, the one-time success rate of sedation and the incidence of sedation-related adverse events were analyzed.Results There was no statistically significant difference in the duration of MRI examination among the four groups (P 0.05). However, significant differences were observed in the onset time of sedation and recovery time among the groups (P 0.05). Comparison of HR at T₀, T₁, and T₂ in all groups showed that HR differed significantly across different time points (P 0.05) and among the groups (P 0.05), with the child group demonstrating lower and relatively more stable HR. The change trend of HR also differed significantly among groups (P 0.05). The one-time success rate of sedation differed significantly among the groups (P 0.05). In contrast, no statistically significant difference was found in the overall incidence of adverse reactions among the four groups (P 0.05).Conclusion CH combined with Dex for non-invasive examinations in children of different ages has a reliable sedative effect. It can effectively maintain the stable stress level of children and has a low incidence of adverse events. Among them, the sedation takes effect faster in the neonatal group and the recovery is more rapid in the infant group. Clinically, it can be reasonably applied according to the age characteristics of children.