咪达唑仑滴鼻用于新生儿腰椎穿刺镇静的有效性和安全性

The Effectiveness and Safety of Midazolam Nasal Drops for Lumbar Puncture Sedation in Neonates

目的观察咪达唑仑滴鼻用于新生儿腰椎穿刺前镇静的有效性和安全性。方法选取2019年8月~2020年2月银川市妇幼保健院新生儿科收治的需行腰椎穿刺术的足月新生儿104例,随机分为实验组和对照组,各52例。实验组在行腰椎穿刺前经鼻滴入咪达唑仑,对照组经鼻腔滴入等量生理盐水。比较两组患儿N-PASS镇静、疼痛评分、腰椎穿刺成功率、损伤率、腰椎穿刺前后平均动脉压、心率及经皮血氧饱和度的变化。结果实验组操作时镇静评分、穿刺成功率高于对照组,镇痛评分、损伤率低于对照组,差异均有统计学意义(P<0.05);实验组穿刺后MAP及HR低于对照组,差异有统计学意义(P<0.05);两组穿刺后SpO2比较,差异无统计学意义(P>0.05)。结论咪达唑仑0.2 mg/kg滴鼻用于新生儿腰椎穿刺时镇静、镇痛效果较好,安全性较高,且对呼吸、循环无明显影响。

Objective To observe the effectiveness and safety of midazolam nasal drops for sedation before lumbar puncture in newborns.Methods A total of 104 full-term newborns who were required to undergo lumbar puncture and were admitted to the Department of Neonatology of Yinchuan Maternal and Child Health Hospital from August 2019 to February 2020 were randomly divided into experimental group and control group,with 52 cases in each group.The experimental group was instilled midazolam through the nose before lumbar puncture,and the control group was instilled the same amount of normal saline through the nose.The changes of N-PASS sedation,pain score,success rate of lumbar puncture,injury rate,average arterial pressure before and after lumbar puncture,heart rate and percutaneous oxygen saturation were compared between the two groups of children.Results The sedation score and puncture success rate of the experimental group during operation were higher than those of the control group,and the analgesia score and injury rate were lower than those of the control group,the differences were statistically significant(P<0.05);After puncture,the MAP and HR of the experimental group were lower than those of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference in SpO2 between the two groups after puncture(P>0.05).Conclusion Midazolam 0.2 mg/kg nasal drops is effective in sedation and analgesia during lumbar puncture of newborns,and it is safe and has no obvious effect on breathing and circulation.