静脉深度镇静用于不配合患儿门诊口腔治疗的回顾性分析

A retrospective analysis of intravenous deep sedation for uncooperative pediatric patients undergoing oral treatment in outpatient clinic

回顾性分析静脉深度镇静用于不配合患儿门诊口腔治疗的效果。选择2015年11月至2018年10月在门诊行口腔常规治疗不配合的患儿,年龄2~10岁,治疗时间<2 h。治疗前采取鼻喷右美托咪定或口服咪达唑仑或鼻喷咪达唑仑或直接吸入七氟醚进行镇静。治疗过程中靶控输注丙泊酚使患儿处于深度镇静状态。共纳入患儿251例,全部成功完成了口腔治疗。治疗前镇静:鼻喷右美托咪定154例(61.4%),口服咪达唑仑14例(5.6%),鼻喷咪达唑仑3例(1.2%),吸入七氟醚80例(31.9%),患儿治疗前均达到理想镇静标准(Ramsay评分≥4分)。治疗过程中发生因体动而暂时中断口腔治疗39例(15.5%),发生呛咳39例(15.5%),发生一过性低氧血症(时间<30 s)32例(12.9%),通过暂停操作、加深麻醉、口腔吸引、托下颌或吸氧等处理后在30 s内恢复正常。恢复室停留期间仅有1例患儿发生躁动(Riker镇静-躁动评分为5分),均未见咽痛、呕吐、误吸、呼吸道梗阻等发生。静脉深度镇静可用于不配合患儿的门诊口腔治疗,提高患儿就医的舒适性。

To retrospectively analyze the efficacy of intravenous deep sedation for uncooperative pediatric patients undergoing oral treatment in outpatient clinic.The uncooperative pediatric patients,aged 2-10 yr,with an expected treatment time<2 h,who underwent oral treatment in outpatient clinic from November 2015 to October 2018,were selected.Dexmedetomidine was delivered via nasal spray,midazolam was taken orally or delivered via nasal spray,and sevoflurane was inhaled for sedation before treatment.Propofol was administered by target-controlled infusion during treatment to make patients achieve deep sedation.A total of 251 patients were enrolled and successfully completed oral therapy.Sedation before treatment:154 cases(61.4%)received dexmedetomidine via nasal spray delivery,14 cases(5.6%)received oral midazolam,3 cases(1.2%)received midazolam via nasal spray delivery,and 80 cases(31.9%)inhaled sevoflurane,and ideal sedation(Ramsay sedation score≥4)was achieved in each pediatric patients.Temporary interruption of oral treatment due to physical activity occurred in 39 cases(15.5%),coughing occurred in 39 cases(15.5%),transient hypoxemia(time<30 s)was found in 32 cases(12.9%),and these conditions returned to normal within 30 s through pausing the operation,deepening anesthesia,oral suction,lower jaw thrust or inhaling oxygen,etc.Only 1 case developed emergence agitation(Riker sedation-agitation scale score 5)during stay in the recovery room.No patients developed complications such as sore throat,vomiting,aspiration or obstruction of the upper respiratory tract.Intravenous deep sedation technique can be used for oral treatment in outpatient clinic in uncooperative pediatric outpatients and raise comfort of medical treatment for pediatric patients.