咪达唑仑口服溶液对扁桃体联合腺样体切除术患儿术前镇静、血流动力学及苏醒期躁动的影响

The effects of midazolam oral solution on preoperative sedation,hemodynamics,and awakening agitation in children undergoing tonsillectomy combined with adenoidectomy

目的探讨咪达唑仑口服溶液对扁桃体联合腺样体切除术患儿术前镇静、血流动力学及苏醒期躁动的影响。方法选取2022年1月至9月在浙江大学医学院附属儿童医院行扁桃体联合腺样体切除术的267例患儿,按照随机数字表法分为低剂量组(n=89)、高剂量组(n=89)和对照组(n=89),麻醉前30 min低剂量组口服0.25 mg/kg咪达唑仑,高剂量组口服0.5 mg/kg咪达唑仑,对照组口服10%葡萄糖混合液5 ml。比较3组患儿的拔管时间、麻醉后恢复室(PACU)滞留时间;给药前及给药10、20、30 min后平均动脉压(MAP)、心率(HR)水平;给药前及给药10、60 min后耶鲁改良围手术期焦虑量表(mYPAS)评分及躁动发生率。结果低剂量组PACU滞留时间少于高剂量组(P<0.05),低剂量组与对照组组间差异无统计学意义(P>0.05)。给药后10、20、30 min时,低剂量组及高剂量组MAP、HR水平均低于给药前(均P<0.05),且给药后10、20、30 min时低剂量组及高剂量组MAP、HR水平均低于对照组(均P<0.05)。给药前,3组mYPAS评分差异无统计学意义(均P>0.05);给药后10、60 min,低剂量组及高剂量组mYPAS评分均低于给药前,且低剂量组及高剂量组mYPAS评分均低于对照组(均P<0.05);给药后10、60 min,对照组mYPAS评分与给药前差异无统计学意义(均P>0.05),低剂量组及高剂量组mYPAS评分组间差异无统计学意义(均P>0.05)。3组躁动发生率比较差异无统计学意义(P>0.05)。结论术前口服0.25 mg/kg或0.5 mg/kg咪达唑仑均能有效减轻扁桃体联合腺样体切除术患儿术前焦虑,改善机体血流动力学,但因咪达唑仑代谢较快,对术后苏醒期躁动的改善效果不大。0.25 mg/kg剂量咪达唑仑相比0.5 mg/kg剂量能够减少PACU滞留时间,值得临床推荐。

Objective To explore the effects of midazolam oral solution on preoperative sedation,hemodynamics,and awakening agitation in children undergoing tonsillectomy combined with adenoidectomy.Methods A total of 267 pediatric patients who underwent tonsillectomy combined with adenoidectomy at the Children's Hospital Affiliated to Zhejiang University School of Medicine from January to September 2022 were randomly divided into a low-dose group(n=89),a high-dose group(n=89),and a control group(n=89)using a random number table method.30 minutes before anesthesia,the low-dose group received 0.25 mg/kg of midazolam orally,the high-dose group received 0.5 mg/kg of midazolam orally,and the control group received 5 ml of 10%glucose mixture orally.We compared the extubation time and post anesthesia recovery room(PACU)retention time among three groups of pediatric patients;Mean arterial pressure(MAP)and heart rate(HR)levels before administration and 10,20,and 30 minutes after administration;The Yale Modified Perioperative Anxiety Scale(mYPAS)score and restlessness incidence were measured before administration and 10 and 60 minutes after administration.Results The retention time of PACU in the low-dose group was shorter than that in the high-dose group(P<0.05),and there was no statistically significant difference between the low-dose group and the control group(P>0.05).At 10,20,and 30 minutes after administration,the levels of MAP and HR in the low-dose and high-dose groups were lower than before administration(all P<0.05),and at 10,20,and 30 minutes after administration,the levels of MAP and HR in the low-dose and high-dose groups were lower than those in the control group(all P<0.05).Before administration,there was no statistically significant difference in mYPAS scores among the three groups(all P>0.05);At 10 and 60 minutes after administration,the mYPAS scores of the low-dose and high-dose groups were lower than before administration,and the mYPAS scores of the low-dose and high-dose groups were lower than those of the control group(all P<0.05);At 10 and 60 minutes after administration,there was no statistically significant difference in mYPAS scores between the control group and before administration(all P>0.05),while there was no statistically significant difference in mYPAS scores between the low-dose and high-dose groups(all P>0.05).There was no statistically significant difference in the incidence of agitation among the three groups(P>0.05).Conclusions Preoperative oral administration of 0.25 mg/kg or 0.5 mg/kg midazolam can effectively alleviate preoperative anxiety and improve hemodynamics in children undergoing tonsillectomy combined with adenoidectomy.However,due to the fast metabolism of midazolam,its effect on improving postoperative restlessness during the recovery period is not significant.The 0.25 mg/kg dose of midazolam can reduce the retention time of PACU compared to the 0.5 mg/kg dose,which is worthy of clinical recommendation.