右美托咪定与咪达唑仑单次最低剂量用于预防儿童苏醒期谵妄的比较：随机对照研究
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial
背景与目的
小儿在七氟醚麻醉后常出现苏醒期谵妄（ED），为保证患儿安全，应予以预防。本研究采用前瞻性、双盲、随机、对照研究旨在比较最低有效剂量的咪达唑仑与右美托咪定预防儿童扁桃体切除术后ED的疗效。
方 法
本研究共纳入70名24个月至12岁的儿童，在扁桃体手术结束前5分钟给予咪达唑仑（0.03 mg/kg）或右美托咪定（0.3μg/kg）。ED的发生率和严重程度分别采用4分评分法和儿童苏醒期躁动（PAED）评分法评估EA发生情况。并记录苏醒期时间和术后疼痛评分。
结 果
咪达唑仑组和右美托咪定组ED发生率分别为31.3% 和26.5% (P=0.668)，两组瞻望的严重程度相似（咪达唑仑组为9.6±5.8, vs.右美托咪定组为8.1±5.9 , P=0.299），两组苏醒期时间相当[咪达唑仑组11.0 (8.3–13.8) min vs. 右美托咪定组12.0 (10.0–13.5) min (P=0.218)].咪达唑仑术后疼痛评分 [0 (0–1)] 较右美托咪定组高 [0 (0–1)] (P=0.011)。
结 论
单次最小剂量的右美托咪定和咪达唑仑在预防儿童ED方面具有同等的疗效，但在手术结束时使用，不会延迟苏醒期时间。关于术后镇痛效果，尽管右美托咪定的镇痛效果明显高于咪达唑仑，但还需要进一步的临床研究来验证我们的发现。
原始文献摘要
Cho EA, Cha YB, Shim JG, et al. Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial.[J] .J Anesth, 2019.
Purpose Emergence delirium (ED) is common in children after sevofurane anesthesia and should be prevented for patient safety. A prospective, double-blind, randomized, controlled study was performed to compare the efficacy of minimal dosage of midazolam versus dexmedetomidine to prevent ED in children undergoing tonsillectomy.
Methods Seventy children aged 24 months to 12 years were allocated to receive midazolam (0.03 mg/kg) or dexmedetomidine (0.3 µg/kg) 5 min before the end of surgery. The incidence and severity of ED were assessed using a four-point scale
and the pediatric anesthesia emergence delirium scale, respectively. The emergence time and postoperative pain scores were also evaluated.
Results The incidence of ED was 31.3% in the midazolam group and 26.5% in the dexmedetomidine group (P=0.668). The severity of ED was similar in both groups (9.6±5.8 in the midazolam group, vs. 8.1±5.9 in the dexmedetomidine group, P=0.299). The emergence time was comparable in the two groups [11.0 (8.3–13.8) min in midazolam group vs. 12.0 (10.0–13.5) min in dexmedetomidine group (P=0.218)]. Postoperative pain score was higher in the midazolam group [0 (0–1)] than in the dexmedetomidine group [0 (0–0)] (P=0.011).
Conclusion Dexmedetomidine and midazolam at single minimum dosages had equal effectiveness to prevent ED in children without delaying emergence time, when administered at the end of surgery. With regards to postoperative analgesic efficacy, although dexmedetomidine showed statistically signifcant higher analgesic effect than midazolam, further clinical investigations are needed to validate our findings.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙