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目的比较咪达唑仑不同途径预先给药预防小儿七氟烷麻醉恢复期躁动(EA)的效果。方法择期扁桃体联合腺样体切除术患儿80例,采用随机数字表法,将其分为4组(n=20),对照组(C组)、口服咪达唑仑组(O组)、肌内注射咪达唑仑组(IM组)与鼻腔内给予咪达唑仑组(IN组)。麻醉前30 min,C组口服10%葡萄糖溶液10 mL,O组、IM组及IN组按不同途径预先分别口服、肌内注射及鼻腔内给予咪达唑仑,剂量依次为0.50,0.15和0.20 mg·kg-1。吸入七氟烷麻醉诱导,静脉输注瑞芬太尼和吸入七氟烷维持麻醉。入手术室前行Ramsay镇静评分、脱离父母难易度评分及父母满意度评分;采用患儿麻醉恢复期躁动量化评分表(PAED)评估患儿EA发生情况。结果与C组比较,O组、IM组、IN组Ramsay、脱离父母难易度及父母满意度评分升高,PAED评分降低,EA发生率降低(P<0.05);与O组比较,IM组、IN组Ramsay及脱离父母难易度评分升高,父母满意度评分降低(P<0.05),PAED评分及EA发生率差异无统计学意义(P>0.05)。结论口服、肌内注射及鼻腔内预先给予咪达唑仑预防小儿七氟烷EA发生的效果相似,且口服给药更易于接受。
Objective To compare the effects of different routes of administration of midazolam on prophylaxis of restless agitation (EA) in sevoflurane anesthesia in children. Methods Totally 80 children with tonsillectomy and adenoidectomy were randomly divided into 4 groups (n = 20), control group (group C), midazolam group (group O) Midazolam group (IM group) and midazolam group (IN group) were intramuscularly injected. 30 min before anesthesia, 10 mL of 10% dextrose solution was given to group C, and orally, intramuscularly and intranasally, respectively, in groups O, IM and IN. The doses were followed by 0.50, 0.15 and 0.20 mg · kg-1. Induction of sevoflurane anesthesia induction, remifentanil intravenous infusion and sevoflurane inhalation to maintain anesthesia. The Ramsay sedation scores were taken out of the operating room before being discharged from the parental difficulty score and parental satisfaction score. The incidence of EA in children was evaluated using the Pediatric Nursing Restoration Agitation Quantification Scale (PAED). Results Compared with group C, Ramsay in group O, group IM and group IN increased from degree of parental difficulty and parental satisfaction, PAED decreased and the incidence of EA decreased (P <0.05). Compared with group O, group IM (P <0.05). There was no significant difference between the Ramsay scores of IN group and those of parents (P> 0.05). There was no significant difference between the scores of PAED and EA (P> 0.05). Conclusion Oral, intramuscular and nasal premedication of midazolam prevented similar effects of sevoflurane in children, and oral administration was easier to accept.