水合氯醛镇静在足月和早产儿中的应用：疗效和并发症分析。
Chloral hydrate sedation in term and preterm infants: an analysis of efficacy and complications.
机构信息
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, 34th St. & Civic Center Blvd., Philadelphia, PA, USA.
出版信息
Anesth Analg. 2010 Mar 1;110(3):739-46. doi: 10.1213/ANE.0b013e3181ca12a8. Epub 2009 Dec 23.
BACKGROUND
Term and preterm infants are at risk of developing apnea after receiving general anesthesia. The risk of apnea after sedation with chloral hydrate (CH) in this population is unknown. In this study, we aimed to describe the clinical course of infants younger than 1 year who received CH for magnetic resonance imaging (MRI), with regard to the efficacy of CH sedation, the need for additional sedative drugs, and the incidence of oxyhemoglobin desaturation or need for oxygen supplementation. We aimed to determine the relationship between these factors to chronological age in term infants and gestational and postconceptional age (PCA) in preterm infants (<37 weeks' gestation).
METHODS
This was a retrospective cohort study of 1394 infants undergoing MRI examination with CH sedation. Infants with an endotracheal tube, tracheostomy tube, or congenital heart disease were excluded. Patient charts were examined in detail to determine independent risk factors and dependent outcome variables up to 24 hours after MRI. Univariate and multivariate analyses were performed to determine risk factors for outcome variables.
RESULTS
Postprocedure oxyhemoglobin desaturation was more likely in inpatients (P < 0.001) and was associated with a lower body weight (3.9 +/- 2.1 kg vs 6.6 +/- 3.0 kg; P < 0.001), history of apnea (33.3% vs 9.9%; P = 0.001), higher ASA physical status (P = 0.002), and younger chronological age (58.7 +/- 82.8 days vs 152 +/- 105.9 days; P < 0.0001). When the preterm group was analyzed separately, the risk of postprocedure oxyhemoglobin desaturation was directly correlated with younger chronological age (56.0 +/- 41.5 days vs 150.6 +/- 107.1 days; P = 0.012) and younger PCA (39.5 +/- 4.1 weeks vs 54.4 +/- 15.2 weeks; P = 0.005), but not gestational age. Preterm infants had more postprocedure bradycardia than term infants (P = 0.005). Postprocedural oxyhemoglobin desaturation was not seen in preterm infants older than 48 weeks' PCA. Because of the relatively small percentage of cases (8 of 262) of postprocedural oxyhemoglobin desaturation in preterm infants, we were not able to definitively determine the difference in incidence between preterm and term infants. Additional doses of CH or supplementation with midazolam did not increase the incidence of complications.
CONCLUSIONS
The occurrence of postprocedural oxyhemoglobin desaturation was directly correlated with younger chronological age in term infants and younger PCA in preterm infants. Term infants who required extended oxygen supplementation were inpatients and had significant comorbidities.
背景
全身麻醉后，早产儿和足月儿均有发生呼吸暂停的风险。氯醛（CH）镇静后发生呼吸暂停的风险在该人群中尚不清楚。本研究旨在描述 1 岁以下接受 CH 进行磁共振成像（MRI）检查的婴儿的临床过程，包括 CH 镇静的疗效、需要额外镇静药物、氧合血红蛋白下降的发生率或需要氧疗的情况。我们旨在确定这些因素与足月婴儿的胎龄和出生后年龄（PCA）以及早产儿（<37 周）的胎龄和 PCA 之间的关系。
方法
这是一项对 1394 名接受 CH 镇静行 MRI 检查的婴儿进行的回顾性队列研究。排除了有气管内管、气管造口管或先天性心脏病的患儿。详细检查病历以确定 MRI 后 24 小时内的独立危险因素和依赖的结局变量。进行单变量和多变量分析以确定结局变量的危险因素。
结果
住院患儿（P < 0.001）和低体重患儿（3.9 ± 2.1kg 比 6.6 ± 3.0kg；P < 0.001）更易发生术后氧合血红蛋白下降，患儿有过呼吸暂停史（33.3%比 9.9%；P = 0.001），ASA 身体状况更高（P = 0.002），胎龄和 PCA 更小（58.7 ± 82.8 天比 152 ± 105.9 天；P < 0.0001）。单独分析早产儿时，术后氧合血红蛋白下降的风险与胎龄和 PCA 较小直接相关（56.0 ± 41.5 天比 150.6 ± 107.1 天；P = 0.012），与胎龄和 PCA 较小直接相关（39.5 ± 4.1 周比 54.4 ± 15.2 周；P = 0.005），但与胎龄无关。早产儿较足月儿更易发生术后心动过缓（P = 0.005）。胎龄和 PCA 大于 48 周的早产儿无术后氧合血红蛋白下降。由于术后氧合血红蛋白下降的早产儿病例相对较少（8 例/262），我们无法明确确定早产儿和足月儿之间的发病率差异。CH 或咪达唑仑的追加剂量并未增加并发症的发生率。
结论
在足月儿中，术后氧合血红蛋白下降的发生率与胎龄和 PCA 较小有关，在早产儿中与胎龄和 PCA 较小有关。需要长期氧疗的足月儿为住院患儿，合并有显著合并症。
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