中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
2期
199-202
,共4页
陈怡绮%张马忠%王璐%许文音%卞勇
陳怡綺%張馬忠%王璐%許文音%卞勇
진이기%장마충%왕로%허문음%변용
水合氯醛%心脏缺损,先天性%清醒镇静%超声心动描记术,多普勒,彩色%剂量效应关系,药物%儿童
水閤氯醛%心髒缺損,先天性%清醒鎮靜%超聲心動描記術,多普勒,綵色%劑量效應關繫,藥物%兒童
수합록철%심장결손,선천성%청성진정%초성심동묘기술,다보륵,채색%제량효응관계,약물%인동
Chloral hydrate%Heart defects,congenital%Conscious sedation%Echocardiography,Doppler,color%Dose-response relationship,drug%Child
目的 评价口服水合氯醛用于先天性心脏病患儿心脏彩超检查镇静的药效学.方法 拟行日间心脏彩超检查的先天性心脏病患儿200例,5 ~ 620日龄,性别不限,ASA分级Ⅱ-Ⅳ级.第1例患儿口服水合氯醛的剂量为50 mg/kg,采用序贯法确定下一例患儿水合氯醛剂量,相邻剂量升高或降低的幅度为10%.基于剂量-效应关系模型进行药效学分析,确定患儿口服水合氯醛镇静的50%和95%有效剂量(E D50和ED95)及其95%可信区间(CI).将协变量(年龄、性别、用药时段、禁食时间、用药前2h内有睡眠、早产和紫绀型先天性心脏病)纳入剂量-效应关系模型,评价各协变量对水合氯醛镇静药效学的影响.结果 口服水合氯醛用于先天性心脏病患儿心脏彩超检查镇静的ED50为42.2 mg/kg(95% CI 40.2~44.2 mg/kg);ED95为67.4 mg/kg(95%CI 53.7 ~ 81.1 mg/kg).各协变量均不影响口服水合氯醛镇静的药效学(P>0.05).将禁食时间和早产纳入剂量-效应关系模型时,剂量-效应关系曲线斜率的95%CI包括0;将年龄分层后纳入剂量-效应关系模型时,难以拟合或数据严重偏离临床.结论 口服水合氯醛用于先天性心脏病患儿心脏彩超检查镇静的ED50和ED95分别为42.2mg/kg(95%CI 40.2~ 44.2 mg/kg)和67.4 mg/kg(95% CI 53.7 ~ 81.1 mg/kg);性别、用药时段、用药前有睡眠和紫绀型先天性心脏病不影响其药效学;年龄、禁食时间和早产对其影响仍需进一步确定.
目的 評價口服水閤氯醛用于先天性心髒病患兒心髒綵超檢查鎮靜的藥效學.方法 擬行日間心髒綵超檢查的先天性心髒病患兒200例,5 ~ 620日齡,性彆不限,ASA分級Ⅱ-Ⅳ級.第1例患兒口服水閤氯醛的劑量為50 mg/kg,採用序貫法確定下一例患兒水閤氯醛劑量,相鄰劑量升高或降低的幅度為10%.基于劑量-效應關繫模型進行藥效學分析,確定患兒口服水閤氯醛鎮靜的50%和95%有效劑量(E D50和ED95)及其95%可信區間(CI).將協變量(年齡、性彆、用藥時段、禁食時間、用藥前2h內有睡眠、早產和紫紺型先天性心髒病)納入劑量-效應關繫模型,評價各協變量對水閤氯醛鎮靜藥效學的影響.結果 口服水閤氯醛用于先天性心髒病患兒心髒綵超檢查鎮靜的ED50為42.2 mg/kg(95% CI 40.2~44.2 mg/kg);ED95為67.4 mg/kg(95%CI 53.7 ~ 81.1 mg/kg).各協變量均不影響口服水閤氯醛鎮靜的藥效學(P>0.05).將禁食時間和早產納入劑量-效應關繫模型時,劑量-效應關繫麯線斜率的95%CI包括0;將年齡分層後納入劑量-效應關繫模型時,難以擬閤或數據嚴重偏離臨床.結論 口服水閤氯醛用于先天性心髒病患兒心髒綵超檢查鎮靜的ED50和ED95分彆為42.2mg/kg(95%CI 40.2~ 44.2 mg/kg)和67.4 mg/kg(95% CI 53.7 ~ 81.1 mg/kg);性彆、用藥時段、用藥前有睡眠和紫紺型先天性心髒病不影響其藥效學;年齡、禁食時間和早產對其影響仍需進一步確定.
목적 평개구복수합록철용우선천성심장병환인심장채초검사진정적약효학.방법 의행일간심장채초검사적선천성심장병환인200례,5 ~ 620일령,성별불한,ASA분급Ⅱ-Ⅳ급.제1례환인구복수합록철적제량위50 mg/kg,채용서관법학정하일례환인수합록철제량,상린제량승고혹강저적폭도위10%.기우제량-효응관계모형진행약효학분석,학정환인구복수합록철진정적50%화95%유효제량(E D50화ED95)급기95%가신구간(CI).장협변량(년령、성별、용약시단、금식시간、용약전2h내유수면、조산화자감형선천성심장병)납입제량-효응관계모형,평개각협변량대수합록철진정약효학적영향.결과 구복수합록철용우선천성심장병환인심장채초검사진정적ED50위42.2 mg/kg(95% CI 40.2~44.2 mg/kg);ED95위67.4 mg/kg(95%CI 53.7 ~ 81.1 mg/kg).각협변량균불영향구복수합록철진정적약효학(P>0.05).장금식시간화조산납입제량-효응관계모형시,제량-효응관계곡선사솔적95%CI포괄0;장년령분층후납입제량-효응관계모형시,난이의합혹수거엄중편리림상.결론 구복수합록철용우선천성심장병환인심장채초검사진정적ED50화ED95분별위42.2mg/kg(95%CI 40.2~ 44.2 mg/kg)화67.4 mg/kg(95% CI 53.7 ~ 81.1 mg/kg);성별、용약시단、용약전유수면화자감형선천성심장병불영향기약효학;년령、금식시간화조산대기영향잉수진일보학정.
Objective To evaluate the pharmacodynamics of oral chloral hydrate sedation for echocardiography in pediatric patients with congenital heart disease (CHD).Methods Two hundred ASA physical status Ⅱ-Ⅳ pediatric patients with CHD, aged 5-620 days,scheduled for elective echocardiography,were enrolled in the study.The dose of oral chloral hydrate was set at 50 mg/kg in the first pediatric patient.The oral dosage was determined by up-and-down sequential experiment.Each time the oral dose increased/decreased by 10% in the next pediatric patient.The pharmacodynamics was analyzed based on the dose-response model to determine the 50% effective dose (ED50),95% effective dose (ED95) and 95% confidence interval (95% CI) of chloral hydrate for sedation.The covariates (age,gender,time period of administration,fasting time,sleeping at 2 h before sedation,premature and cyanotic CHD) were introduced into the dose-response model,and the effect of each covariate on the pharmacodynamics of chloral hydrate sedation was evaluated.Results The ED50 of chloral hydrate for sedation during echocardiography was 42.2 mg/kg (95 % CI 40.2-44.2 mg/kg), ED95 was 67.4 mg/kg (95% CI 53.7-81.1 mg/kg) in the pediatric patients with CHD.Each covariate provided no effect on the pharmacodynamics of chloral hydrate sedation (P > 0.05).When fasting time and premature were introduced into the dose-response model,95% CI of the slope of dose-response curve included 0.When age which was stratified was introduced into the dose-response model,it was difficult to fit or the data seriously deviated from the clinical data.Conclusion The ED50 and ED95 of chloral hydrate for sedation during echocardiography were 42.2 mg/kg (95% CI 40.2-44.2 mg/kg) and 67.4 mg/kg (95%CI 53.7-81.1 mg/kg),respectively,in the pediatric patients with CHD.Gender,time period of administration,sleeping before sedation and cyanotic CHD do not affect the pharmacodynamics of oral chloral hydrate sedation,while the effect of age,fasting time and premature needs further determination.