右美托咪定对比间断吗啡用于亚低温治疗的脑病新生儿的镇静。
Dexmedetomidine versus intermittent morphine for sedation of neonates with encephalopathy undergoing therapeutic hypothermia.
机构信息
Department of Pharmacy, Bellevue Hospital Center, New York, NY, USA.
Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA.
出版信息
J Perinatol. 2021 Sep;41(9):2284-2291. doi: 10.1038/s41372-021-00998-8. Epub 2021 Mar 1.
OBJECTIVE
In March 2019, the sedative in the therapeutic hypothermia protocol at Bellevue Hospital Center and NYU Langone Health changed from morphine to dexmedetomidine. This study evaluated the impact of this change on efficacy and safety parameters.
STUDY DESIGN
This was a retrospective, observational cohort study including neonates with HIE undergoing therapeutic hypothermia (N = 70) at two regional perinatal medical centers.
RESULTS
Baseline demographics, pain scores, hemodynamics, and time to enteral feeds were similar between dexmedetomidine (N = 34) and morphine (N = 36) patients. Dexmedetomidine patients received more breakthrough morphine (0.13 ± 0.13 vs 0.04 ± 0.09 mg/kg, p = 0.001), but less cumulative morphine (0.13 ± 0.13 vs 1.79 ± 0.23 mg/kg, p < 0.0001). Morphine patients on invasive ventilation required increased support (0 vs 31.58%, p = 0.02).
CONCLUSION
Dexmedetomidine is effective and safe for sedation and analgesia during therapeutic hypothermia. It reduced total opioid usage, with no increased incidence of adverse events.
目的
2019 年 3 月，贝维尤医院中心和纽约大学朗格尼健康中心的治疗性低温治疗方案中的镇静剂从吗啡改为右美托咪定。本研究评估了这一变化对疗效和安全性参数的影响。
研究设计
这是一项回顾性、观察性队列研究，纳入了在两个区域性围产医学中心接受治疗性低温治疗的 HIE 新生儿（N=70）。
结果
右美托咪定组（N=34）和吗啡组（N=36）的基线人口统计学、疼痛评分、血液动力学和开始肠内喂养的时间相似。右美托咪定组患者接受了更多的突破性吗啡（0.13±0.13 与 0.04±0.09mg/kg，p=0.001），但累积吗啡用量更少（0.13±0.13 与 1.79±0.23mg/kg，p<0.0001）。需要有创通气的吗啡组患者需要更多支持（0%与 31.58%，p=0.02）。
结论
右美托咪定用于治疗性低温治疗时镇静和镇痛有效且安全。它减少了阿片类药物的总用量，且没有增加不良事件的发生率。
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