3种镇静方案用于孤独症患儿口腔治疗的效果研究

Clinical Study on Efficacy of Three Different Sedation Methods in Dental Treatment of Autistic Children.

目的:探讨3种不同镇静方案在孤独症儿童牙科诊疗中的镇静效果。方法:选取Frankl量表评分为1分的孤独症谱系障碍患儿91例,随机分为3组:M1组29例,予肌注0.20 mg/kg咪达唑仑镇静;M2组33例,予肌注0.24 mg/kg咪达唑仑镇静;MD组29例,予肌注0.20 mg/kg咪达唑仑联合鼻喷2μg/kg右旋美托咪定镇静。采用行为量表评估镇静效果。24 h后电话回访患儿不良反应及家长满意度。结果:所有患儿生命体征平稳,未出现严重不良反应。MD组镇静程度深于M1组(P<0.001)和M2组(P=0.004),M2组镇静程度深于M1组(P=0.047),镇静深度与镇静方案有关,与年龄、性别、治疗项目、口腔治疗史均无关。3组镇静成功率分别为31.0%、42.4%、65.5%,具有统计学差异(P=0.027)。治疗完成率差异没有统计学意义(P=0.616)。3组镇静起效时间分别为(15.148±2.429)min、(17.818±2.325)min、(20.571±4.167)min,具有统计学差异(P<0.001)。术后3组家长各有86.2%、90.9%、86.2%表示对镇静满意且下次就诊仍愿意选择镇静辅助治疗,均较镇静前持积极态度者增多。结论:对于孤独症患儿,3种镇静方案均有效。联合用药组镇静程度最深,镇静成功率最高,但镇静起效慢。

Objective:To determine the effectiveness and safety of three different sedation methods on patients with autism spectrum disorder during dental treatment.Methods:Ninety-one autistic children were selected and randomly divided into three groups,i.e.group M1(n=29),group M2(n=33),and group MD(n=29).They received intramuscular midazolam in 0.2 mg/kg,0.24 mg/kg,and 0.2 mg/kg with intranasal dexmedetomidine in 2μg/kg for sedation,respectively.Sedation effectiveness was analyzed by behavioral rating scales.Telephone following-ups were performed 24 hours after treatment to record the side effects and parents'satisfaction.Results:Children's vital signs were stable and no severe complications occurred.The degree of sedation in group MD was the deepest(group M1 vs.group MD,P<0.001;group M2 vs.group MD,P=0.004;group M1 vs.Group M2,P=0.047).The sedation depth had no relationship with age,sex,treatment program,or history.The sedation success rates in three groups were 31.0%(group M1),42.4%(group M2),and 65.5%(group MD),with a significant difference among them.There was no significant difference in the treatment completion rates among three groups.The satisfaction rates of parents were 86.2%,90.9%,and 86.2%,which were higher than the acceptance rates before treatment.Conclusion:Intramuscular midazolam with or without intranasal dexmedetomidine was an effective sedation method in dental treatment of pediatric patients with autism spectrum disorder.Combination of intramuscular midazolam and intranasal dexmedetomidine was associated with the best sedation effectiveness and the highest sedation success rate but longest onset time,when compared to other two groups of intramuscular midazolam.