关键词:

右美托咪定, 咪达唑仑, 头颅磁共振成像, 精神障碍, 儿童, 镇静效果

Abstract:

Objective　To evaluate the sedative effects of different doses of dexmedetomidine combined with midazolam on children with mental disorders undergoing cranial magnetic resonance imaging (MRI). Methods　This study was a randomized controlled trial. From January 2021 to October 2023, 84 children with mental disorders requiring cranial MRI at Xi'an Traditional Chinese Medicine Brain Disease Hospital were enrolled in this study, and were divided into two groups according to the random number table method. In the low-dose group, there were 23 boys and 19 girls, aged (5.95±0.93) years, 9 cases of autism, 7 cases of hyperactivity disorders, 7 cases of depression, 5 cases of anxiety disorders, and 14 other cases. In the high-dose group, there were 25 boys and 17 girls, aged (5.84±0.97) years, 8 cases of autism, 7 cases of hyperactivity disorders, 11 cases of depression, 6 cases of anxiety disorders, and 10 other cases. At 30 min before MRI examination, the low-dose group was given 2 μg/kg of dexmedetomidine via nasal drip and 0.1 mg/kg of midazolam via intravenous injection, and the high-dose group was given 3 μg/kg of dexmedetomidine via nasal drip and 0.1 mg/kg of midazolam via intravenous injection. The coordination (completion rate and incidence of agitation), vital signs at different time points (heart rate, blood pressure, and pulse oxygen saturation), sedation effects (modified Ramsay sedation scale scores 10, 20, 30, 40, and 50 min after administration), and adverse events were observed in the two groups. χ² test and t test were used. Results　There were no statistically significant differences in the examination completion rate or incidence of agitation between the low dose group and the high dose group [85.71% (36/42) vs. 90.48% (38/42), 21.43% (9/42) vs. 19.05% (8/42)] (χ²=0.045, P=0.500; χ²=0.074, P=0.786). There were no statistically significant differences in the heart rate, mean arterial pressure, or pulse oxygen saturation between the two groups before administration (all P>0.05). The heart rate and mean arterial pressure of the low-dose group were higher than those of the high-dose group 10 to 50 min after sedation (all P<0.05). The pulse oxygen saturation of the low-dose group was higher than that of the high-dose group 10 to 40 min after sedation (all P<0.05), and there was no statistically significant difference between the two groups 50 min after sedation (P>0.05). There was no statistically significant difference in the Ramsay score between the two groups 10 to 50 min after sedation (all P>0.05). The incidence of adverse events in the low dose group was lower than that in the high dose group [4.76% (2/42) vs. 19.05% (8/42)], with a statistically significant difference (χ²=4.086, P=0.043). Conclusion　Low-dose dexmedetomidine combined with midazolam administered nasally is safe and effective, suitable for children with mental disorders undergoing cranial MRI.

Key words:

Dexmedetomidine, Midazolam, Cranial magnetic resonance imaging, Mental disorders, Children, Sedative effect