2种术前镇静用药对小儿全凭静脉麻醉术中qCON和qNOX及维持用药的影响

doi:10.11958/20260438

天津医药 ›› 2026, Vol. 54 ›› Issue (8): 865-869.doi: 10.11958/20260438

2种术前镇静用药对小儿全凭静脉麻醉术中qCON和qNOX及维持用药的影响

郑宏茹(), 王志芬^△(), 李明珊, 王昊琦, 元新颖, 杜琳娜, 刘金柱

天津大学儿童医院/天津市儿童医院麻醉科（邮编300134）

收稿日期:2026-02-09 修回日期:2026-04-13 出版日期:2026-08-15 发布日期:2026-08-07
通讯作者: △E-mail：wzf9001@126.com
作者简介:郑宏茹（1972），女，副主任医师，主要从事儿科麻醉方面研究。E-mail：zhr598@163.com
基金资助:
天津市卫生健康科技项目(TJWJ2025QN064);天津市医学重点学科建设项目(TJYXZDXK-3-016B)

Effects of two preoperative sedative regimens on intraoperative qCON and qNOX and maintenance anesthetic requirements in pediatric total intravenous anesthesia

ZHENG Hongru(), WANG Zhifen^△(), LI Mingshan, WANG Haoqi, YUAN Xinying, DU Linna, LIU Jinzhu

Department of Anesthesiology, Tianjin University Children's Hospital/Tianjin Children's Hospital, Tianjin 300134, China

Received:2026-02-09 Revised:2026-04-13 Published:2026-08-15 Online:2026-08-07
Contact: △E-mail: wzf9001@126.com

郑宏茹, 王志芬, 李明珊, 王昊琦, 元新颖, 杜琳娜, 刘金柱. 2种术前镇静用药对小儿全凭静脉麻醉术中qCON和qNOX及维持用药的影响[J]. 天津医药, 2026, 54(8): 865-869.

ZHENG Hongru, WANG Zhifen, LI Mingshan, WANG Haoqi, YUAN Xinying, DU Linna, LIU Jinzhu. Effects of two preoperative sedative regimens on intraoperative qCON and qNOX and maintenance anesthetic requirements in pediatric total intravenous anesthesia[J]. Tianjin Medical Journal, 2026, 54(8): 865-869.

摘要/Abstract

摘要：

目的基于意识指数（qCON）和伤害感受指数（qNOX）监测，评估术前鼻喷右美托咪定和咪达唑仑静脉注射对小儿全凭静脉麻醉（TIVA）术中麻醉深度和维持用药的影响。方法本研究为前瞻性、随机、双盲对照试验，纳入行扁桃体和腺样体射频消融术患儿79例（年龄3~6岁，体质量10~25 kg）。按随机数字表法分为3组：A组（未用镇静药，27例）、B组（鼻喷2.0~2.5 μg/kg右美托咪定，26例）、C组（静脉注射0.05 mg/kg咪达唑仑，26例）。麻醉诱导均为：舒芬太尼+依托咪酯+丙泊酚+顺式阿曲库铵，同时静脉泵注丙泊酚+瑞芬太尼，术中通过调整泵注剂量，维持qCON值在40~60，qNOX值在30~80。记录麻醉诱导前（T0）、气管插管前（T1）、手术开始后5 min（T2）、停药前（T3）各时间点的血流动力学指标、qCON和qNOX、瑞芬太尼与丙泊酚术中泵注剂量，及术后苏醒情况。结果 T2—T3期间B组和C组的qCON和qNOX均明显低于A组（P<0.05）；A、B、C组瑞芬太尼和丙泊酚剂量依次降低，C组术后拔管时间长于A组和B组（P<0.05），苏醒期Richmond躁动-镇静量表（RASS）评分低于A组和B组（P<0.05）。结论在小儿丙泊酚联合瑞芬太尼TIVA中，术前鼻喷右美托咪定和静脉注射咪达唑仑均能加深麻醉深度，降低qCON和qNOX值，减少瑞芬太尼剂量，咪达唑仑可协同显著减少丙泊酚剂量，但会轻度延长术后拔管时间。

关键词: 右美托咪定, 咪达唑仑, 伤害感受指数, 意识指数, 小儿麻醉

Abstract:

Objective To evaluate the effects of preoperative intranasal dexmedetomidine and intravenous midazolam on anesthesia depth and maintenance drug requirements during pediatric total intravenous anesthesia (TIVA), as monitored by the consciousness index (qCON) and nociceptive index (qNOX). Methods This prospective, randomized, double-blind controlled trial enrolled 79 children (aged 3-6 years, weighing 10-25 kg) scheduled for radiofrequency ablation of tonsils and adenoids. Patients were randomly divided into three groups: group A (no premedication, n=27), group B (intranasal dexmedetomidine 2.0-2.5 μg/kg, n=26), and group C (intravenous midazolam 0.05 mg/kg, n=26). Anesthesia was induced with sufentanil, etomidate, propofol, and cisatracurium, followed by continuous intravenous infusion of propofol and remifentanil. Infusion rates were adjusted intraoperatively to maintain qCON between 40 and 60, and qNOX between 30 and 80. Hemodynamic parameters, qCON and qNOX values, intraoperative infusion doses of remifentanil and propofol, and postoperative recovery profiles were recorded at four time points: before anesthesia induction (T0), before tracheal intubation (T1), 5 minutes after surgery commencement (T2), and before discontinuation of anesthetics (T3). Results During T2-T3, qCON and qNOX values in the group B and C were significantly lower than those in the group A (P<0.05). The maintenance doses of both remifentanil and propofol decreased sequentially across groups A, B, and C. The extubation time in the group C was significantly longer than that in the group A and B (P<0.05), and the richmond agitation-sedation scale (RASS) score during the recovery period was significantly lower in the group C than in the group A and B (P<0.05). Conclusion In pediatric TIVA with propofol and remifentanil, preoperative intranasal dexmedetomidine and intravenous midazolam both deepen anesthesia, reduce qCON and qNOX values, and decrease the required dose of remifentanil. Midazolam can significantly reduce propofol consumption synergistically, but may mildly prolong postoperative extubation time.

Key words: dexmedetomidine, midazolam, quantum nociceptive index, quantum consciousness index, pediatric anesthesia

中图分类号:

R614.2，R765.4

图/表 4

参考文献 26

[1]	Bajwa S, Vinayagam S, Shinde S, et al. Recent advancements in total intravenous anaesthesia and anaesthetic pharmacology[J]. Indian J Anaesth, 2023, 67(1):56-62. doi:10.4103/ija.ija_1022_22.
[2]	冯艺, 许军军, 中华医学会麻醉学分会中国全凭静脉麻醉临床实践指南(2024版)编写组. 中国全凭静脉麻醉临床实践指南(2024版)[J]. 中华麻醉学杂志, 2024, 44(9):1030-1049.
	Feng Y, Xu J J, Chinese Society of Anesthesiology Task Force on Clinical Practice Guidelines for Total Intravenous Anesthesia(2024). Chinese clinical practice guidelines for total intravenous anesthesia(2024 edition)[J]. Chin J Anesthesiol, 2024, 44(9):1030-1049. doi:10.3760/cma.j.cn131073.20240911.00902.
[3]	史静, 王鸿雁, 石磊, 等. 右美托咪定和咪达唑仑应用于小儿静脉麻醉中的效果比较[J]. 河北医药, 2019, 41(15):2284-2287.
	Shi J, Wang H Y, Shi L, et al. Comparison of dexmedetomidine and midazolam for intravenous anesthesia in pediatric patients[J]. Hebei Med J, 2019, 41(15):2284-2287. doi:10.3969/j.issn.1002-7386.2019.15.010.
[4]	邬冬云. 右美托咪定滴鼻在儿科临床镇静中的应用现状[J]. 临床医学研究与实践, 2021, 6(36):192-195.
	Wu D Y. Application status of intranasal dexmedetomidine for sedation in pediatric clinic[J]. Clin Res Pract, 2021, 6(36):192-195. doi:10.19347/j.cnki.2096-1413.202136062.
[5]	张麟临, 李依泽, 王国林. 围手术麻醉期伤害感受监测的研究现状及应用前景[J]. 临床麻醉学杂志, 2024, 40(10):1013-1016.
	Zhang L L, Li Y Z, Wang G L. Research status and application prospects of nociception monitoring during perioperative anesthesia[J]. J Clin Anesthesiol, 2024, 40(10):1013-1016. doi:10.12089/jca.2024.10.001.
[6]	Linassi F, Vide S, Ferreira A, et al. Relationships between the qNOX,qCON,burst suppression ratio,and muscle activity index of the CONOX monitor during total intravenous anesthesia: a pilot study[J]. J Clin Monit Comput, 2024, 38(6):1281-1290. doi:10.1007/s10877-024-01214-6.
[7]	Melia U, Gabarron E, Agustí M, et al. Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery[J]. J Clin Monit Comput, 2017, 31(6):1273-1281. doi:10.1007/s10877-016-9948-z.
[8]	IWK Health Centre. Midazolam-pediatric drug dosing guidelines[EB/OL].(2023-04-28)[2026-02-05]. https://www.dir.iwk.nshealth.ca/Home/DDGDetails/fd025ab6-887d-e911-80f2-005056b200d2?PatientPopulation=Ped.
[9]	上海恒瑞医药有限公司. 盐酸右美托咪定鼻喷雾剂说明书[Z]. 艾倍美^®,国药准字H20230025, 2023:4-5.
	Shanghai Hengrui Pharmaceutical Co.,Ltd. Dexmedetomidine hydrochloride nasal spray package insert[Z]. Abeimei^®,National Drug Approval Number H20230025. 2023:4-5.
[10]	Freriksen J J M, Van Der Zanden T M, Holsappel I G A, et al. Best evidence-based dosing recommendations for dexmedetomidine for premedication and procedural sedation in pediatrics:outcome of a risk-benefit analysis by the Dutch Pediatric Formulary[J]. Pediatric Drugs, 2022, 24(3):247-257. doi:10.1007/s40272-022-00498-y.
[11]	Suresh S, Ecoffey C, Bosenberg A, et al. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia[J]. Reg Anesth Pain Med, 2018, 43(2):211-216. doi:10.1097/AAP.0000000000000702.
[12]	Giordano A, Lehner B, Voicu A, et al. Intranasal dexmedetomidine for sedation in ABR testing in children: no pain,big gain![J]. Int J Pediatr Otorhinolaryngol, 2024, 181:111981. doi:10.1016/j.ijporl.2024.111981.
[13]	袁志浩, 韩建阁, 王欣悦. 右美托咪啶经口腔颊黏膜术前用药对全麻患儿苏醒期躁动的影响[J]. 天津医药, 2021, 49(2):207-211.
	Yuan Z H, Han J G, Wang X Y. Effect of preoperative buccal administration of dexmedetomidine on emergence agitation in children undergoing general anesthesia[J]. Tianjin Med J, 2021, 49(2):207-211. doi:10.11958/20200346.
[14]	Kim H J, Shin W J, Park S, et al. The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods:a systematic review and meta-analysis[J]. J Clin Anesth, 2017, 38:33-39. doi:10.1016/j.jclinane.2017.01.014.
[15]	Afonso J, Reis F. Dexmedetomidine:current role in anesthesia and intensive care[J]. Rev Bras Anestesiol, 2012, 62(1):118-133. doi:10.1016/S0034-7094(12)70110-1.
[16]	Yuen V M, Hui T W, Irwin M G, et al. A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia: a double-blinded randomized controlled trial[J]. Anesth Analg, 2008, 106(6):1715-1721. doi:10.1213/ane.0b013e31816c8929.
[17]	Praveen M, Kumar A, Parikh B, et al. Evaluation of qCON and qNOX indices in pediatric surgery under general anesthesia[J]. J Anaesthesiol Clin Pharmacol, 2024, 40(2):264-270. doi:10.4103/joacp.joacp_453_22.
[18]	Scaramuzzo G. Effect of goal-directed analgesia and sedation using EEG derived qCON/qNOX in ICU patients undergoing mechanical ventilation:a randomized controlled trial[EB/OL]. (2025-01-09)[2025-12-03]. https://clinicaltrials.gov/study/NCT06769308.
[19]	Peter J U, Dieudonné P, Zolk O. Pharmacokinetics,pharmacodynamics,and side effects of midazolam: a review and case example[J]. Pharmaceuticals (Basel), 2024, 17(4):473. doi:10.3390/ph17040473.
[20]	Li R, Wang Q, Liu Z, et al. Dose-dependent pharmacokinetics of midazolam in rats: influence of hepatic first-pass metabolism[J]. Xenobiotica, 2023, 53(3):184-192. doi:10.1080/00498254.2023.2200524.
[21]	Azimaraghi O, Rudolph M I, Luedeke C M, et al. Association of dexmedetomidine use with haemodynamics,postoperative recovery,and cost in paediatric anaesthesia: a hospital registry study[J]. Br J Anaesth, 2024, 133(2):326-333. doi:10.1016/j.bja.2024.03.016.
[22]	Li S, Liu T, Xia J, et al. Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: a randomized controlled study[J]. BMC Ophthalmol, 2020, 20(1):86. doi:10.1186/s12886-020-01359-3.
[23]	Zanner R, Schneider G, Meyer A, et al. Time delay of the qCON monitor and its performance during state transitions[J]. J Clin Monit Comput, 2021, 35(2):379-386. doi:10.1007/s10877-020-00480-4.
[24]	Rogozov V, Vanek T, Maly M, et al. The nociceptive response during adult cardiac surgery measured by the qNOX index: A feasibility study[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2024, 168(1):62-67. doi:10.5507/bp.2022.045.
[25]	Weerink M, Struys M, Hannivoort L N, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J]. Clin Pharmacokinet, 2017, 56(8):893-913. doi:10.1007/s40262-017-0507-7.
[26]	中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中华儿科杂志编辑委员会. 中国儿童重症监护病房镇痛和镇静治疗专家共识(2024)[J]. 中华儿科杂志, 2024, 62(3):196-203.
	Emergency Medicine Group of Chinese Pediatric Society, Pediatric Group of Chinese Society of Emergency Medicine, Editorial Committee of Chinese Journal of Pediatrics. Expert consensus on analgesia and sedation therapy in pediatric intensive care units in China(2024)[J]. Chin J Pediatr, 2024, 62(3):196-203. doi:10.3760/cma.j.cn112140-20231130-00400.

组别	n	年龄/ 岁	体质量/ kg	性别（男/女）	ASA分级（Ⅰ/Ⅱ）	手术时间/min
A组	27	5.0（3.5，5.5）	16.78±2.30	16/11	18/9	33.19±7.83
B组	26	4.5（4.0，5.0）	18.00±2.37	15/11	19/7	35.73±7.16
C组	26	4.0（3.3，5.0）	17.46±1.99	15/11	18/8	35.23±9.16
H、F或χ²		2.376	2.006	0.018	0.260	0.741

组别	n	年龄/ 岁	体质量/ kg	性别（男/女）	ASA分级（Ⅰ/Ⅱ）	手术时间/min
A组	27	5.0（3.5，5.5）	16.78±2.30	16/11	18/9	33.19±7.83
B组	26	4.5（4.0，5.0）	18.00±2.37	15/11	19/7	35.73±7.16
C组	26	4.0（3.3，5.0）	17.46±1.99	15/11	18/8	35.23±9.16
H、F或χ²		2.376	2.006	0.018	0.260	0.741

组别	n		HR/（次/min）
组别	n		T0		T1		T2		T3
A组	27		103.9±7.6		106.9±6.6		111.3±7.7		105.6±7.2
B组	26		95.3±10.3^a		96.1±8.2^a		92.7±7.9^a		95.7±7.2^a
C组	26		97.2±5.1^a		104.5±5.6^b		101.0±5.3^ab		105.2±8.8^b
F			8.617^＊＊		17.720^＊＊		46.957^＊＊		13.628^＊＊
组别		MAP/mmHg
组别		T0		T1		T2		T3
A组		75.0±7.0		76.7±6.3		74.3±5.7		73.9±5.8
B组		75.4±5.1		73.9±5.1		71.3±7.1		70.3±4.6
C组		72.4±8.2		75.8±7.5		72.2±6.6		71.9±6.6
F		1.440		1.307		1.443		2.501

组别	n		HR/（次/min）
组别	n		T0		T1		T2		T3
A组	27		103.9±7.6		106.9±6.6		111.3±7.7		105.6±7.2
B组	26		95.3±10.3^a		96.1±8.2^a		92.7±7.9^a		95.7±7.2^a
C组	26		97.2±5.1^a		104.5±5.6^b		101.0±5.3^ab		105.2±8.8^b
F			8.617^＊＊		17.720^＊＊		46.957^＊＊		13.628^＊＊
组别		MAP/mmHg
组别		T0		T1		T2		T3
A组		75.0±7.0		76.7±6.3		74.3±5.7		73.9±5.8
B组		75.4±5.1		73.9±5.1		71.3±7.1		70.3±4.6
C组		72.4±8.2		75.8±7.5		72.2±6.6		71.9±6.6
F		1.440		1.307		1.443		2.501

组别	n		qCON
组别	n		T0		T1		T2		T3
A组	27		95.3±1.8		39.5±4.5		48.7±5.2		53.5±2.9
B组	26		95.0±1.6		35.5±4.6^a		37.7±6.1^a		44.6±4.2^a
C组	26		95.4±2.0		37.3±4.6		35.6±5.9^a		44.0±4.7^a
F			0.296		5.247^＊＊		40.090^＊＊		47.166^＊＊
组别		qNOX
组别		T0		T1		T2		T3
A组		95.6±1.9		47.3±3.2		52.1±3.8		67.7±6.4
B组		94.8±2.7		33.3±2.7^a		36.9±4.2^a		44.5±4.6^a
C组		94.9±2.0		34.7±3.2^a		34.6±3.1^a		41.5±4.3^a
F		1.131		172.415^＊＊		171.414^＊＊		203.693^＊＊

2种术前镇静用药对小儿全凭静脉麻醉术中qCON和qNOX及维持用药的影响

Effects of two preoperative sedative regimens on intraoperative qCON and qNOX and maintenance anesthetic requirements in pediatric total intravenous anesthesia

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 4

参考文献 26

相关文章 15

编辑推荐

Metrics

本文评价

组别	n		T2—T3瑞芬太尼剂量/ （μg·kg^-1·min^-1）		T2—T3丙泊酚剂量/（mg·kg^-1·h^-1）
A组	27		0.89±0.04		9.53±0.63
B组	26		0.42±0.03^a		8.41±0.48^a
C组	26		0.38±0.04^ab		5.64±0.24^ab
H或F			1496.624^＊＊		464.068^＊＊
组别		拔管时间/min		苏醒期RASS评分/分
A组		13.00±1.47		-1.00（-2.00，-0.50）
B组		12.58±1.72		-1.00（-1.75，-0.25）
C组		16.23±2.01^ab		-1.00（-2.00，-1.00）^ab
H或F		34.318^＊＊		8.472^＊

[1]	谢银冬, 周颖, 李艳平, 牛亚静, 苏启超. 右美托咪定调控CCL2-CCR2通路对胆囊癌细胞生物学行为的影响[J]. 天津医药, 2025, 53(12): 1233-1240.
[2]	朱咏仪, 温博伦, 吴青霖, 梁少玲, 宗银东. 右美托咪定对孕产妇椎管内麻醉期间寒战及血流动力学的影响[J]. 天津医药, 2024, 52(4): 387-390.
[3]	孙高悦, 钟晓倩, 张倩倩, 李云. 改良胸腰筋膜间平面阻滞对腰椎减压融合术患者术后恢复质量的影响[J]. 天津医药, 2023, 51(3): 286-289.
[4]	李秋畅, 闫顺昌, 蒙亚珍, 顾云霞, 宁巧明, 李娜, 王志华. Nrf2-GPX4介导的铁死亡通路参与右美托咪定对脑出血大鼠神经保护作用的机制研究[J]. 天津医药, 2022, 50(8): 817-821.
[5]	杨蓉蓉, 徐兴国, 卞小翠, 黄新冲. 不同剂量右美托咪定联合罗哌卡因胸椎旁神经阻滞在胸外科手术中的应用[J]. 天津医药, 2022, 50(12): 1324-1329.
[6]	魏晓永, 刘茜, 徐玲兰, 董正华, 赵军博, 刘博, 姜丽华. 右美托咪定镇静复合罗哌卡因骶管阻滞用于新生儿会阴肛门成形术的效果[J]. 天津医药, 2021, 49(9): 973-976.
[7]	计天珍, 李锐, 朱海娟, 刘红霞, 张野. 右美托咪定滴鼻预防硬膜外分娩镇痛爆发痛的效果观察[J]. 天津医药, 2021, 49(7): 742-747.
[8]	张雷, 朱咏仪, 赵年章, 梁少玲. 基于NF-κB/ICAM-1通路探讨右美托咪定对子痫前期大鼠的神经保护作用[J]. 天津医药, 2021, 49(11): 1158-1162.
[9]	崔松勤, 黄红芳, 黄雪莲, 芮骁, 黄赛赛. 七氟烷预处理和右美托咪定对老年食管癌患者术后认知功能的影响[J]. 天津医药, 2021, 49(10): 1089-1093.
[10]	李国利, 高晓茹, 王暐, 张悦, 曹亮, 李福龙, 滕金亮 △. 右美托咪定复合舒芬太尼对肺癌患者术后镇痛效果及细胞免疫功能的影响 #br#[J]. 天津医药, 2020, 48(5): 396-401.
[11]	陈前修, 李天梅, 刘行. 右美托咪定在老年2型糖尿病患者止血带下肢手术中的应用#br#[J]. 天津医药, 2020, 48(12): 1210-1213.
[12]	徐丽张玉坤吴江陈军嵇富海杨建平. 艾司洛尔联合右美托咪定对重型颅脑创伤患者去骨瓣减压术后脑代谢及预后的影响[J]. 天津医药, 2020, 48(11): 1069-1073.
[13]	邓姗, 李平. 右美托咪定在骨科手术中的应用进展[J]. 天津医药, 2019, 47(6): 658-662.
[14]	梁小丽, 桂欢, 刘程曦, 张超, 徐珊, 张益, 朱昭琼. 右美托咪定减轻新生期大鼠重复七氟醚吸入导致的远期突触可塑性损害[J]. 天津医药, 2019, 47(3): 250-255.
[15]	张莉, 何咸兵. 右美托咪啶复合丙泊酚在乳腺麦默通微创旋切术中的应用[J]. 天津医药, 2019, 47(2): 171-174.