小儿术前不同用药方法对围术期应激反应的影响

Effect of different premedications on the stress perioperatively in children

目的探讨术前不同用药方法对患儿围术期镇静抗焦虑程度的影响。方法48例下腹部手术患儿,术前用药按苯巴比妥钠2mg/kg(对照组)、咪唑安定0.08mg/kg(研究Ⅰ组)肌注及咪唑安定0.5mg/kg加50%葡萄糖容积为0.2ml/kg(研究Ⅱ组)口服,随机分组对比分析,测定三组给药前后平均动脉压(MAP)和心率(HR)的变化、患儿接受率、镇静催眠效果满意度以及血清皮质醇(Cs)、血糖(BS)浓度变化。结果三组给药前后MAP、HR的变化无显著性差异。研究Ⅱ组患儿接受率为87.50%,镇静催眠效果满意度为81.25%,以及血清Cs、BS浓度下降程度均明显高于其他两组(P<0.05,P<0.01)。结论口服咪唑安定易于接受,镇静作用佳,可作为良好的小儿术前镇静用药。

Objective To explore the effect of different premedications on the sedation and apprehension perioperatively in children.Methods Forty-eight children undergoing lower abdominal operation were randomly divided into three groups.Control group received premedication with phenobarbital sodium 2mg/kg i.m.,experiment group(Ⅰ)with 0.08mg/kg midazolam i.m. and experiment group(Ⅱ) with 0.2mg/kg midazolam and 0.5ml/kg 50% glucose o.p. MAP,HR,serum concentrations of cortisol and blood sugar were measured before and after premedication . The rate of cheerful acceptance and degree of satisfaction in sedation hypnosis by children was evaluated.Results There was no difference in MAP and HR before and after premedication. The rate of cheerful acceptance and degree of satisfaction in sedation hypnosis in groupⅡ was better than that in the other two groups(P<0.01).The serum concentrations of cortisol and blood sugar were significantly decreased in groupⅡ(P<0.05).Conclusion Oral midazolam was easily accepted and resulted in well effect,and can be used as a sedation manner before operation.