右美托咪定镇静状态下，儿童认知记忆测量的可行性

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Feasibility of measuring memory response to increasing dexmedetomidine sedation in children

背景与目的

右美托咪定对儿童记忆的影响尚未有前瞻性的研究，本研究主要确定是否能在儿童患者中获取质量可靠的数据用以建立记忆和镇静反应间的模型。采用标准的视觉图片命名任务来评估当镇静程度逐渐加深时的记忆。研究的次要观察指标建立时间与右美托咪定镇静效应（丧失语言反应）和存在认知记忆的回归模型。

方  法

需镇静的儿童在10分钟内静脉输注右美托咪定2ug/kg。100幅研究图片在静脉输注开始后以5秒每张匀速播放，直至患儿闭眼。反应时间为开始呈现图片至患儿命名图片。当患儿苏醒后，开始测量患儿的认知记忆。100张研究图片以同样速度和顺序播放。任何语言反应无论正确与否均认为是阳性结果。患儿以“是”指认在右美托咪定负荷量输注阶段见过的图片，“否”则相反。

                  结  果

64名受试儿童中，共30名接受右美托咪定镇静并完成所有研究内容，30名完成研究任务的儿童的不同反应都可成功建立起模型，这提示此方法的可行性；245s时，50%儿童出现无认知状态；340s时，50%儿童出现镇静状态，出现时间晚于无认知状态。

结  论

静脉输注右美托咪定期间，可以评估儿童镇静反应和记忆功能，且儿童记忆功能存在并持续至对语言指令无反应前即刻。

原始文献摘要

Mason K P, Kelhoffer E R, Prescilla R, et al. Feasibility of measuring memory response to increasing dexmedetomidine sedation in children[J]. British Journal of Anaesthesia, 2017, 118(2):254.

Background： The memory effect of dexmedetomidine has not been prospectively evaluated in children. We evaluated the feasibility of measuring memory and sedation responses in children during dexmedetomidine sedation for non-painful radiological imaging studies. Secondarily, we quantified changes in memory in relation to the onset of sedation.

Methods： A 10min bolus of dexmedetomidine (2mcg kg-1) was given to children as they named simple line drawings every five s. The absence of sedation was identified as any verbal response, regardless of correctness. After recovery, recognition memory was tested with correct Yes/No recognitions (50% novel pictures) and was matched to sedation responses during the bolus period (subsequent memory paradigm).

Results：Of 64 accruals, 30 children (mean [SD]6.1 (1.2) yr, eight male) received be modelled successfully in the 30 children completing all the study tasks, demonstrating feasibility of this approach. Children had 50% probability of verbal response at five min 40 s after infusion start,whereas 50% probability of subsequent recognition memory occurred sooner at four min five s.

Conclusions：Quantifying memory and sedation effects during dexmedetomidine infusion in verbal children was possible and demonstrated that memory function was present until shortly before verbal unresponsiveness occurred. This is the first study to investigate the effect of dexmedetomidine on memory in children.

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