咪唑安定与七氟醚对扁桃腺切除患儿苏醒的影响

Effects of midazolam on the recovery of sevoflurane combined anesthesia in children with tonsillectomy

目的观察不同剂量咪唑安定对小儿扁桃体切除术后七氟醚麻醉恢复质量和意识恢复时间的影响。方法选取2017年9月至2018年6月在湖州市中心医院实施扁桃腺切除的60例患儿为研究对象,将60例患儿随机分为A、B、C三组,每组20例。对A组、B组患儿分别采用0.04mg/kg、0.07mg/kg咪唑安定联合七氟醚实施复合麻醉,对C组患儿单独使用七氟醚实施麻醉。在手术开始前将七氟醚经气管插入维持麻醉,手术结束前约10min拔管使患儿停吸七氟醚,送入麻醉苏醒室(PACU)。记录患儿从送入麻醉苏醒室到苏醒所用时间、开始恢复意识所用时间、苏醒后儿童躁动情况、苏醒后患儿呼吸道并发症发生例数及七氟醚用药量,并进行统计分析。结果咪唑安定可显著降低七氟醚用药量,C组分别与A组和B组比较差异均有统计学意义(t值分别为12.440、12.224,均P<0.001)。C组与A、B两组比较,患儿苏醒所用时间显著延长(C组vs. B组,t=17.934,P<0.05;C组vs. A组,t=12.895,P<0.05);意识恢复情况与苏醒情况基本保持一致。咪唑安定可显著降低患儿苏醒后躁动,C组分别与A组和B组比较差异均有统计学意义(t值分别为7.605、8.247,均P<0.001),但是增大咪唑安定浓度不能进一步降低患儿苏醒后躁动评分(A组vs. B组,t=0.641,P>0.05)。结论咪唑安定可显著降低扁桃腺切除患儿七氟醚复合麻醉苏醒后的躁动程度,无呼吸道消化道并发症,但咪唑安定会延长患儿苏醒所用时间及意识恢复所用时间。

Objective To observe the effects of different doses of midazolam on recovery quality and consciousness recovery time of sevoflurane anesthesia in children with tonsillectomy. Methods Sixty children with tonsillectomy performed in Huzhou Center Hospital from September 2017 to June 2018 were selected as study subjects, and they were randomly divided into group A, group B and group C with 20 cases in each. In group A combination of 0.04 mg/kg of midazolam and sevoflurane was used for compound anesthesia. In Group B, 0.07 mg/kg of midazolam combined with sevoflurane was used for compound anesthesia. In group C sevoflurane anesthesia was used. Sevoflurane was inserted into trachea to maintain anesthesia prior to the start of surgery. The catheter was extubated approximately 10 minutes before the end of surgery to allow the patient to aspirate sevoflurane, and patients were sent to PACU. The time from the sending to wake-up, the time for resuming consciousness, the child’s agitation after resuscitation, the number of cases of respiratory complications after resuscitation, and the amount of sevoflurane used were recorded. Results Midazolam could significantly decrease the dosage of sevoflurane, and the difference between group C and group A as well as group B was significant(t value was 12.440 and 12.224, respectively, both P<0.001). Compared with group C, the time of recovery in group A and B was significantly longer(group C vs. group B t=17.934,P<0.05;group C vs. group A t=12.895,P<0.05), but the consciousness recovery and analepsia were same. Midazolam could significantly reduce the restlessness after recovery, and the difference between group C and group A as well as group B was significant(t value was 7.605 and 8.247, respectively, both P<0.001). But increasing the concentration of midazolam did not further reduce the restlessness score(group A vs. group B t=0.6414, P>0.05).Conclusion Midazolam can significantly reduce the degree of agitation after resuscitation of sevoflurane combined anesthesia in children with tonsillectomy, and there is no gastrointestinal complications. But midazolam will prolong the analepsia time and recovery time of consciousness.