笑气联合咪达唑仑在智障儿童口腔治疗中的应用研究

Evaluation of N_2O inhalation in combination with oral Midazolam sedation in pediatric dentistry of children with intellectual disability

目的在笑气镇静联合咪达唑仑口服镇静条件下对智障患儿实施口腔治疗,评估镇静的有效性及安全性。方法纳入91例在口腔诊疗中不配合的智障患儿,随机分为笑气镇静组、咪达唑仑口服镇静组、联合组。笑气镇静组:给予35%~50%浓度的笑气镇静;咪达唑仑口服镇静组:给予0.50~0.75 mg/kg咪达唑仑口服镇静;联合组:笑气镇静联合咪达唑仑口服镇静。记录治疗中患儿的心率、呼吸、血氧饱和度,以及治疗内容和持续时间,患儿的治疗完成状况采用Houpt量表评估,跟踪记录患儿24 h内的反应。结果联合组的成功率(83.9%)高于笑气镇静组(53.3%)和咪达唑仑口服镇静组(56.7%)(P<0.05)。笑气镇静组不良反应发生率为6.7%,联合组的不良反应发生率为6.5%,均低于咪达唑仑口服镇静组(33.3%)。结论智障儿童行口腔治疗时,笑气镇静联合咪达唑仑口服镇静是一种安全有效的镇静方法,其成功率高于单独使用笑气镇静或咪达唑仑口服镇静,其不良反应发生率低于单独口服咪达唑仑镇静。

Objective To evaluate the effect of N2O inhalation in combination with oral Midazolam sedation on uncooperative patients with intellectual disability in pediatric dentistry.Methods Ninety-one uncooperative pediatric patients with intellectual disability in the Outpatient Department were divided into3groups.The patients of the N2O group received N2O(35%-50%)inhalation conscious sedation.The patients of the Midazolam group received oral Midazolam(0.50-0.75mg/kg)conscious sedation.The patients of the combination group received N2O inhalation and oral Midazolam conscious sedation.The heart rate,breathing rate,oxygen saturation of blood,treatment content and treatment time during oral therapy were recorded.The status of treatment was evaluated with Houpt system.All kinds of reactions within24hours were recorded.Treatment results and safety were statistically analyzed by Chisquare test with SPSS17.0software package.Results The success rates of the N2O group and the Midazolam group were53.3%and56.7%respectively,which were lower than83.9%of the combination group(P<0.05).The adverse reaction rate in the Midazolam group(33.3%)was higher than that in the combination group(6.5%)and the N2O group(6.7%).Conclusions The combination of N2O inhalation with oral Midazolam conscious sedation is effective and safe for dental treatment of uncooperative pediatric patients with intellectual disability,the incidence of adverse reactions is lower than that of Midazolam sedation alone.