咪达唑仑滴鼻用于小儿术前药的效果观察

Study on the effects of intranasal midazolam for premedication in children

目的观察咪达唑仑滴鼻作为小儿术前药的安全性及有效性。方法选择择期行腺样体或伴有扁桃体切除,年龄2-7岁,ASA分级Ⅰ级的小儿患者60例。随机分成咪达唑仑组（MZ组）及对照组（NS组）,每组30例,MZ组术前30 min经鼻给予咪达唑仑0.2 mg/kg（容量配至1 mL）,NS组术前30 min经鼻给予1 mL生理盐水。记录患儿的基础情绪及给药后鼻腔不适感的发生情况,同时监测给药即刻至入手术室前患儿的脉搏（HR）、血压（BP）、血氧饱和度（SpO2）,记录患儿给药后30 min的镇静评分、情绪评分、与父母分离抵抗评分、静脉穿刺抵抗评分、面罩抵抗评分及不良反应发生情况。术中记录患儿的HR、BP、SpO2、手术时间、拔管时间及术后恶心呕吐、嗜睡等不良反应的发生情况。结果 MZ组的镇静评分、情绪评分、与父母分离评分、静脉穿刺抵抗评分、面罩抵抗评分分别为3、3、3、3、4分,均高于NS组的2分,差异有统计学意义（U=170.5、179、131、197、169.5;Z=-4.81、-4.45、-5.21、-4.01、-4.30;P〈0.05）,两组患儿给药后至麻醉诱导前、术中以及苏醒期血流动力学、血氧饱和度波动和不良反应发生情况比较差异无统计学意义（P〉0.05）。结论经鼻应用咪达唑仑对小儿术前有镇静作用,且对循环呼吸无影响,不延长拔管时间。

Objective To observe the safety and efficacy of intranasal midazolam for premedication in children.Methods 60 ASAⅠ,2 - 7 year old children undergoing elective tonsillectomy with or without adenoidectomy,were randomly assigned into group MZ and group NS,30 cases in each group.Group MZ administrated midazolam 0.2 mg /kg,intranasal,and group NS administrated normal 1 mL intranasal,30 min before operation.Basic emotions and malaises after intranasal administration of the two groups were recorded,and heart rate（HR）,blood pressure（BP）,hemoglobin oxygen saturation were monitored from intranasal administration to operation room.The scores of sedation,emotion,behaviour at separation from parents,venepuncture,induction and the adverse effects were observed.HR,BP,SpO2,time of operation and extubation,postoperative nausea and vomiting,sleepiness of the children were recorded.Results The scores of sedation,emotion,behaviour at separation from parents,venepuncture,induction of group MZ was significantly higher than those of group NS（3 vs.2,3 vs.2,3 vs.2,3 vs.2,4 vs.2;U = 170.5,179,131,197,169.5;Z =-4.81,-4.45,-5.21,-4.01,-4.30;P 〈0.05）.There was no significant difference in hemodynamic and respiratory variables,time of extubation and adverse effects after administration,before anesthesia induction,during operation and recovery period between the two groups（P〉 0.05）.Conclusion Preoperative intranasal midazolam can definitely sedate children without prolonging the time to extubate and affecting hemodynamics and respiratory variables.