Terndrup T E, Dire D J, Madden C M, Gavula D, Cantor R M
Department of Emergency Medicine, State University of New York Health Science Center, Syracuse.
Ann Emerg Med. 1993 Feb;22(2):206-11. doi: 10.1016/s0196-0644(05)80204-5.
To compare the effectiveness of intramuscular meperidine (2 mg/kg) and promethazine (1 mg/kg) with chlorpromazine (MPC) or without chlorpromazine (MP) (1 mg/kg) for sedation of children undergoing emergency department procedures.
Randomized, double-blind trial.
A community and university hospital ED.
Eighty-seven hemodynamically and neurologically stable children less than 16 years old.
IM sedation followed by intended procedure.
Children receiving either combination were not significantly different with regard to age, sex, weight, chronic illness, and indications. Procedures included laceration repair (46), fracture reduction (25), and others (16). Mean onset of action was similar (16 +/- 12 minutes), whereas the duration of action was significantly longer after MPC (63 +/- 57 minutes [mean +/- SD] compared with MP 29 +/- 36 minutes; P < .05, Student's t-test). Paradoxical hyperactivity occurred only after MP (three of 43 cases; P = NS, Fisher's exact test), whereas transient oxygen desaturation occurred only after MPC (one of 44 cases; P = NS). No other serious complications were observed. Three observers rated the effectiveness of sedation and analgesia on separate 10.2-cm visual-analog scales. Overall, MPC received significantly better ratings (7.4 +/- 2.1 cm) than MP (5.7 +/- 3.0 cm; P < .05, Mann-Whitney U test). Parents believed sedation worked well in 90% of cases. Their children had bad memories of the procedure in only 9% of cases.
Elimination of chlorpromazine from the IM combination of meperidine and promethazine for pediatric sedation during ED procedures results in a significant reduction in efficacy.
比较肌肉注射哌替啶（2mg/kg）和异丙嗪（1mg/kg）联合或不联合氯丙嗪（MPC或MP，1mg/kg）用于急诊科接受诊疗操作儿童镇静的效果。
随机双盲试验。
社区及大学医院急诊科。
87名年龄小于16岁、血流动力学和神经功能稳定的儿童。
肌肉注射镇静药物后进行预定操作。
接受两种联合用药方案的儿童在年龄、性别、体重、慢性病及适应证方面无显著差异。操作包括伤口缝合（46例）、骨折复位（25例）及其他（16例）。平均起效时间相似（16±12分钟），而MPC组的作用持续时间显著更长（63±57分钟[均值±标准差]，MP组为29±36分钟；P<.05，学生t检验）。反常性多动仅在MP组出现（43例中有3例；P=无显著性差异，Fisher精确检验），而短暂性氧饱和度下降仅在MPC组出现（44例中有1例；P=无显著性差异）。未观察到其他严重并发症。三名观察者在单独的10.2厘米视觉模拟量表上对镇静和镇痛效果进行评分。总体而言，MPC组的评分（7.4±2.1厘米）显著高于MP组（5.7±3.0厘米；P<.05，Mann-Whitney U检验）。90%的家长认为镇静效果良好。其子女仅在9%的情况下对操作有不良记忆。
在急诊科操作期间用于儿童镇静的哌替啶和异丙嗪肌肉注射联合用药方案中去除氯丙嗪会导致疗效显著降低。
