咪达唑仑、氯胺酮单独与联合静脉注射对小儿全麻术前焦虑的影响

Efficacy of intravenous premedication: Midazolam,Ketamine, and combination of both on reducing stress in pediatric patients before general anesthesia

目的小儿手术麻醉中患儿易受与父母分离、医疗操作、环境等因素影响产生焦虑情绪,造成一定程度的精神创伤,甚至出现恐惧、遗尿、抑郁、焦虑等后遗症。诱导前静脉给药能够有助于解决这个问题,静脉注射咪达唑仑、氯胺酮及咪达唑仑与氯胺酮联合用药能够有助于减轻手术患儿焦虑,增强患儿依从性。方法年龄1~6岁的90例实施择期腹腔镜疝气手术的患儿,ASAⅠ~Ⅱ级,随机均分为3组(每组30例),M组静脉注射咪达唑仑0.08 mg/kg,K组静脉注射氯胺酮1 mg/kg,M+K组静脉注射咪达唑仑0.04 mg/kg+氯胺酮0.5 mg/kg,给药前,给药后,诱导前及诱导后进行为类型评分和镇静评分。记录麻醉时间、苏醒时间、血压、心率。比较3组行为和苏醒评分用秩和检验。比较血压和心率用平均数和标准差。结果全麻前静脉给药的患儿行为类型评分M+K组好于K组和M组(P<0.001)。麻醉后,3组行为类型评分比较差异无统计学意义(P=0.454)。全麻前静脉给药后3组苏醒评分不同,M+K组镇静深度高于其他两组(P<0.001)。结论咪达唑仑0.04 mg/kg,氯胺酮0.5 mg/kg联合静脉注射比其余两组米达唑仑0.1 mg/kg和氯氨酮1 mg/kg单独静脉注射提供更适合的镇静深度和更好的行为依从性。

Objective Most children before anesthesia show a lot of stress and anxiety.We assessed the efficacy and safety of intravenous midazolam, intravenous ketamine, and combination of both to reduce the anxiety and improve behavior in children undergoing general anesthesia. Methods 90 pediatric patients preparing to undergo Laparoscopic Hernia Repair aged 6 months to 6 years with American Society of Anesthesiologist grade I or II were enrolled. Children were randomly divided into three groups to receive intravenous midazolam 0.08 mg/kg(M), or intravenous ketamine 1 mg/kg(K), or combination of half doses of both(M+K). Before premedication, after premedication, before induction, and after anesthesia in the postanesthesia care unit behavior types and sedation scores were recorded. The heart rate, blood pressure,oxygen saturation were observed in different time points. Results After premedication, children's behavior was significantly better in the combination group(P < 0.001). After premedication Sedation scores of the combination group was significantly more sedated than the other two groups(P < 0.001). Conclusion Combination of0.04 mg/kg of intravenous midazolam and 0.5 mg/kg of intravenous ketamine as premedication produced more deep sedation and more behavior of compliance compared with other two teams.