右美托咪定与咪达唑仑在儿童牙科患者术前镇静中的应用

Comparison of Oral Dexmedetomidine and Midazolam for Premedication in Children after Dental Procedures

目的:比较术前右美托咪定滴鼻和咪达唑仑口服对儿童牙科患儿术前的镇静效果以及术后躁动的影响。方法:选择择期行儿童牙科治疗的患儿60例,ASAⅠ级,3~6岁,均在全身麻醉下实施口腔修复治疗,按照随机数字表法为两组,右美托咪定组(DEX组)和咪达唑仑组(MID组),每组30例,分别采用右美托咪定2μg/kg滴鼻和咪达唑仑0.5 mg/kg口服。记录Ramsay镇静评分、与父母分离焦虑评分(Parental Separation Anxiety Scale,PSAS)、麻醉面罩接受评分(Mask Acceptance Scale,MAS)、小儿麻醉术后躁动评分(Pediatric Anesthesia Emergence Delirium Scale,PAEDS)以及血流动力学参数。患儿的Ramsay镇静评分和血流动力学参数分别在给药前即刻,给药后10 min,20 min,30 min观察记录。结果:MID组“令人满意的”面罩接收率为93.33%;DEX组也为93.33%,两组之间比较差异没有统计学意义(P=1.00)。MID组“成功地与父母分离”人数比例为93.33%,DEX组为96.67%,两组之间比较差异没有统计学意义(P=0.95)。MID组躁动发生率为20%,DEX组为0,差异有统计学意义(P=0.01)。结论:右美托咪定滴鼻和咪达唑仑口服均能为患儿提供满意的镇静效果,与父母分离以及麻醉面罩接受情况,两组比较没有明显差异。右美托咪定组的患儿术后躁动发生率明显低于咪达唑仑组。

Objective: To compare the effect of oral dexmedetomidine and oral midazolam on preoperative cooperation among children who underwent dental procedures. Methods: Sixty patients were equally randomized divided into two groups: midazolam group(n=30) and dexmedetomidine group(n=30). Midazolam was taken orally with 0.5 mg/kg. Dexmedetomidine was taken orally with 2 μg/kg. The changes of heart rate(HR), respiratory rate(RR), and blood oxygen saturation(SpO2) of the two groups were recorded before premedication and 10 min, 20 min, and 30 min after administration. Ramsay sedation rating scale was used to evaluate the sedation effect of two groups. The acceptance rate of face mask, the parental separation anxiety scale, and emergence delirium scale were observed. Results: At 10 min, 20 min, and 30 min after administration, there was no significant difference in HR, RR, and SpO2 between two groups(P>0.05). The Ramsay scores at 10 min, 20 min, and 30 min after premedication were not statistically different(P>0.05) in both groups. The rate of acceptance face mask and separation from parental were not statistically different(P>0.05) in both groups. The incidence of emergence delirium in dexmedetomidine group was lower than that of midazolam group(P<0.05). Conclusion: Dexmedetomidine is a safe and effective sedative agent for pediatric anesthetic premedication.