Molon Marizete, Piva Jefferson, Karcher Patrícia, Baldissera Trudiane
UFRGS.
Departamento de Pediatria, FM, UFRGS.
Rev Bras Ter Intensiva. 2007 Sep;19(3):284-91.
In our country, the abstinence syndrome has high prevalence and besides the distress prolongs the length of hospital stay. The aim of this study was to evaluate the influence of associating oral clonidine to the intravenous morphine plus midazolam continuous infusion in children submitted to mechanical ventilation.
Randomized, double blind, placebo controlled study, conducted in the PICU at the Hospital Geral of Caxias do Sul. All children (1-36 months) submitted to mechanical ventilation over 12 hours (May-2005/August-2006), which had used intravenous morphine and midazolam continuous infusion were included. They were randomized to received clonidine (5 µg/kg) or placebo associated to the sedative continuous infusion. The infusion sedative doses were at the discretion of the assistant physician. The administered doses in the previous 24 hours and the doses of intermittent sedation were daily collected. The abstinence syndrome was defined based on Finnegan Score. The groups were compared regarding the cumulative doses of sedatives, length of use of sedative continuous infusion, presence and duration of the abstinence.
Were included 69 patients (31 in the clonidine group and 38 in the placebo group). The two groups were similar regarding the general characteristics (weight, age, gender, indication of mechanical ventilation). The midazolam and morphine doses (cumulative and intermittent doses) were not different in both groups. Completed the study 59 patients, 25 in clonidine group and 34 in placebo group. The prevalence of the abstinence was similar (72% and 75%, respectively), without difference in the recovery time neither related to the length of mechanical ventilation.
In children submitted to mechanical ventilation using high dose of opioids and diazepinic infusion the addiction of clonidine did not decrease the daily doses neither the cumulative doses and nevertheless reduced the prevalence and the evolution of abstinence syndrome.
在我国，戒断综合征患病率较高，且其带来的痛苦会延长住院时间。本研究旨在评估口服可乐定联合静脉注射吗啡加咪达唑仑持续输注对接受机械通气儿童的影响。
在南卡希亚斯综合医院的儿科重症监护病房进行随机、双盲、安慰剂对照研究。纳入所有接受机械通气超过12小时（2005年5月至2006年8月）且使用静脉注射吗啡和咪达唑仑持续输注的1至36个月儿童。他们被随机分为接受可乐定（5μg/kg）或与镇静剂持续输注联合使用的安慰剂组。输注镇静剂的剂量由助理医师酌情决定。每天收集前24小时的给药剂量和间歇性镇静剂量。根据芬尼根评分定义戒断综合征。比较两组镇静剂的累积剂量、镇静剂持续输注的使用时间、戒断的存在情况和持续时间。
纳入69例患者（可乐定组3例，安慰剂组38例）。两组在一般特征（体重、年龄、性别、机械通气指征）方面相似。两组咪达唑仑和吗啡剂量（累积剂量和间歇性剂量）无差异。59例患者完成研究，可乐定组25例，安慰剂组34例。戒断患病率相似（分别为72%和75%），戒断恢复时间与机械通气时间无关且无差异。
在使用高剂量阿片类药物和苯二氮䓬类输注进行机械通气的儿童中，可乐定的添加并未降低每日剂量和累积剂量，但减少了戒断综合征的患病率和病程。
