Parkinson L, Hughes J, Gill A, Billingham I, Ratcliffe J, Choonara I
Department of Pharmacy, Alder Hey Children's Hospital, Liverpool, UK.
Paediatr Anaesth. 1997;7(5):405-10. doi: 10.1046/j.1460-9592.1997.d01-109.x.
A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P < 0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/ distressed) was significantly greater in the midazolam group (Chi-squared P < 0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.
开展了一项随机对照试验，比较：a）口服水合氯醛与异丙嗪的组合，和b）持续静脉输注咪达唑仑，用于危重症儿童的维持镇静。使用专门设计的镇静量表每四小时评估一次镇静水平。44名儿童进入研究，其中两名随后被排除。水合氯醛与异丙嗪组的满意评估次数（期望和实际镇静水平相等）显著更多（卡方检验P<0.01；差异的置信区间为0.06至0.20）。咪达唑仑组在镇静量表5级（患者烦躁不安/痛苦）的评估次数显著更多（卡方检验P<0.05）。两组的满意评估总数分别仅为61%和48%，表明镇静效果可大幅改善。在危重症儿童的维持镇静方面，水合氯醛和异丙嗪比咪达唑仑更有效。前瞻性研究危重症儿童镇静药物的疗效是可行的。
