咪达唑仑滴鼻与酮咯酸氨丁三醇超前镇痛对减少小儿麻醉苏醒期躁动的影响

目的探讨咪达唑仑滴鼻与酮咯酸氨丁三醇超前镇痛对小儿麻醉效果及减少苏醒期躁动的影响。方法2015年3月至2017年3月接受手术治疗的患）L70例，按照随机数表法分为对照组与观察组，各35例。对照组不予超前镇痛，观察组予以咪达唑仑滴鼻与酮咯酸氨丁三醇超前镇痛，比较两组患儿镇静评分、苏醒期躁动评分及入手术室时（TO）、拔管时（T1）的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO，）。结果观察组患儿镇静评分（3．1±0．2）分，苏醒期躁动评分为（9．2±0．4）分；对照组患儿分别为（2．9±0．1）分、（13．6±0．5）分，两组比较差异有统计学意义（P〈0．05）。与TO时比较，对照组患儿MAP、HR明显升高（P〈0．05）；与对照组患儿T1时比较，观察组患）LMAP、HR更低（P〈0．05）；两组SpO2比较差异无统计学意义（V〉0．05）。结论在小儿麻醉中给予咪达唑仑滴鼻与酮咯酸氨丁三醇超前镇痛效果更好，可更好的稳定患儿动脉压与心率，减轻苏醒期躁动反应，临床应用价值高，值得全面借鉴与推广。

Objective To explore the influence of intranasal midazolam combined with the preemptive analgesia with ketorolac tromethamine on the pediatric patients. Methods From March 2015 to March 2017, seventy patients scheduled for elective were randomized into two groups： control group and the experimental group, with 35 cases in each group. The control group was not ana/gesia in advance, the experiment group was given intranasal midazolam and the preemptive analgesia with ketorolac tromethamine. The sedation scores and the emergency agitation scores were recorded, the heart rate （ HR ） , mean arterial pressure （ MAP ） and pulse oxygen saturation （ SpO2 ） were recorded after admission to operating room （ TO ） , immediately after removing tube （ T1 ） , two group scores were statistically compared. Results The score of preanesthesia sedation （ 3.1 ± 0.2 ） and emergence agitation （ 9.2 ± 0.4 ） were significantly better than those （ 2.9 ±0.1, 13.6 ±0.5 ） in the control group （ P〈0.05 ） . Compared with TO, the MAP and the HR, the control group was significantly higher than the experiment group （ P〈0.05 ） . Compared with T1, the MAP and the HR were significantly lower than the control group （ P〈0.05 ） , the SpO2 was no statistical difference between two groups. Conclusions The application that midazolam intranasally combined with the preemptive analgesia ketorolac tromethamine before the induction of general anesthesia in pediatric anesthesia, not only can obtain better sedation and significant analgesic effect, maintain MAP and HR, but also significantly reduce the emergence agitation, and it worthy of clinical application and promotion.