Buck Marcia L, Willson Douglas F
Department of Pharmacy Services, University of Virginia Children's Hospital, Charlottesville, Virginia 22908, USA.
Pharmacotherapy. 2008 Jan;28(1):51-7. doi: 10.1592/phco.28.1.51.
To determine the safety, effectiveness, and dosing of dexmedetomidine in intensive care infants and children who require sedation, and the rationale for patient selection.
Prospective observational study.
Eleven-bed pediatric intensive care unit in a university-affiliated children's hospital.
Seventeen infants and children who received dexmedetomidine consecutively between May 4, 2005, and May 4, 2006.
Data were collected on demographics, blood pressure and heart rate measurements, and adverse effects. The rationale for dexmedetomidine use, its dosing, use of other sedatives, and treatment duration were also recorded. Twenty treatment courses in 17 patients (median age 5 mo, range 1 mo-17 yrs) were evaluated. Ten patients (59%) had chronic neurologic impairments (including Down syndrome in nine [53%]). Thirteen (76%) had undergone cardiac surgery, two (12%) had respiratory failure, one (6%) had endocarditis, and one (6%) had undergone scoliosis repair. In 15 (75%) of 20 cases, dexmedetomidine was started to minimize the use of midazolam before extubation; in 13 (87%) of these cases, the patients were extubated within 24 hours. The remaining patients could not tolerate midazolam, and dexmedetomidine was used as an alternative. No loading doses were given. The mean +/- SD starting dose was 0.2 +/- 0.2 microg/kg/hour, with a maximum of 0.5 +/- 0.2 microg/kg/hour. Mean +/- SD duration was 32 +/- 21 hours (range 3-75 hrs); 10 courses exceeded 24 hours. Mean arterial pressures before and after starting treatment were not significantly different (p=0.76), nor were values at discontinuation (p=0.31) or 12 hours later (p=0.29). No significant differences were noted in heart rate at the start (p=0.09), at discontinuation (p=0.06), or 12 hours later (p=0.17). One patient (6%) developed hypotension; no other adverse effects were noted.
With careful patient selection and a conservative approach to dosing, dexmedetomidine was a useful sedative in children requiring mechanical ventilation. It allowed for a reduction or elimination of other sedatives, and it was particularly useful in children with chronic neurologic impairments. Dexmedetomidine was well tolerated, with no clinically significant effects on blood pressure or heart rate.
确定右美托咪定在需要镇静的重症监护婴幼儿及儿童中的安全性、有效性和给药剂量，以及患者选择的依据。
前瞻性观察研究。
一所大学附属医院的拥有11张床位的儿科重症监护病房。
2005年5月4日至2006年5月4日期间连续接受右美托咪定治疗的17例婴幼儿及儿童。
收集了人口统计学数据、血压和心率测量值以及不良反应。还记录了使用右美托咪定的依据、给药剂量、其他镇静剂的使用情况及治疗持续时间。对17例患者（中位年龄5个月，范围1个月至17岁）的20个治疗疗程进行了评估。10例患者（59%）患有慢性神经功能障碍（其中9例[53%]为唐氏综合征）。13例（76%）接受了心脏手术，2例（12%）患有呼吸衰竭，1例（6%）患有心内膜炎，1例（6%）接受了脊柱侧弯修复手术。在20例中的15例（75%）中，开始使用右美托咪定是为了在拔管前尽量减少咪达唑仑的使用；在其中13例（87%）中，患者在24小时内拔管。其余患者不能耐受咪达唑仑，使用右美托咪定作为替代。未给予负荷剂量。平均±标准差起始剂量为0.2±0.2微克/千克/小时，最大剂量为0.5±0.2微克/千克/小时。平均±标准差持续时间为32±21小时（范围3至75小时）；10个疗程超过24小时。开始治疗前后的平均动脉压无显著差异（p = 0.76），停药时（p = 0.31）或12小时后（p = 0.29）的数值也无显著差异。开始时（p = 0.09）、停药时（p = 0.06）或12小时后（p = 0.17）的心率无显著差异。1例患者（6%）出现低血压；未观察到其他不良反应。
通过谨慎的患者选择和保守的给药方法，右美托咪定对需要机械通气的儿童是一种有用的镇静剂。它可减少或避免使用其他镇静剂，对患有慢性神经功能障碍的儿童尤其有用。右美托咪定耐受性良好，对血压和心率无临床显著影响。
