静脉注射咪达唑仑用于小儿麻醉前用药的临床观察

Clinical Observation of Intravenous Injection of Midazolam for Preanesthetic Medication in Children

目的:探讨小儿七氟烷麻醉术前静脉注射不同剂量咪达唑仑的安全性和有效性。方法:选取2016年9—12月择期行疝囊高位结扎术的腹股沟斜疝患儿60例,按随机数字表法分为三组,各20例。I组静脉注射咪达唑仑0.05 mg/kg,Ⅱ组静脉注射咪达唑仑0.08 mg/kg,Ⅲ组口服咪达唑仑0.5 mg/kg。全身麻醉均采用七氟烷吸入诱导和维持,切皮前3 min静脉给予芬太尼1μg/kg以维持麻醉及减轻术后疼痛。观察三组麻醉前镇静评分,入室后心率、血氧饱和度(SpO_2)、呼吸频率、呼气末二氧化碳分压(PETCO2)最高值以及苏醒时间、苏醒期躁动评分。结果:三组入室后心率、呼吸频率和苏醒期躁动评分差异无统计学意义(P>0.05)。Ⅱ组SpO_2低于Ⅰ组、Ⅲ组(P<0.05),Ⅱ组PETCO2最高值与Ⅰ组、Ⅲ组比较差异有统计学意义(P<0.05)。Fun K镇静评分Ⅱ组优于Ⅰ组和Ⅲ组,差异有统计学意义(P<0.05)。苏醒时间Ⅰ组、Ⅱ组均短于Ⅲ组,Ⅱ组面罩诱导满意率高于Ⅲ组,差异均有统计学意义(P<0.05)。结论:小儿七氟烷麻醉术前静脉注射咪达唑仑(0.08 mg/kg)起效快,术后苏醒用时少,安全性好,达到更好的镇静效果。

Objective:To investigate the safety and efficacy of intravenous injection of different doses of midazolam before sevoflurane anesthesia in children. Methods: 60 indirect inguinal hernia children scheduled to undergo high ligation of hernia sac from September 2016 to December 2016 were enrolled and divided into three groups according to the random number table method, 20 cases in each group. In group I, midazolam was administered intravenously at 0.05 mg/kg; in groupⅡ, midazolam was administered intravenously at 0.08 mg/kg; in group Ⅲ, midazolam was administered orally at 0.5 mg/kg. General anesthesia was induced and maintained by sevoflurane inhalation, and fentanyl was given intravenously at 1 μg/kg 3 min before skin incision to maintain anesthesia and reduce postoperative pain. The sedation score before anesthesia, heart rate, blood oxygen saturation(SpO_2), respiratory rate, the highest value of end-expiratory carbon dioxide partial pressure(PETCO2) after entering the operating room, awakening time and pediatric anesthesia emergence delirium scale score in the three groups were observed. Results: There was no significant difference in heart rate, respiratory rate after entering the operating room and pediatric anesthesia emergence delirium scale score in the three groups(P>0.05). SpO_2 in groupⅡwas lower than that in groupⅠand groupⅢ(P<0.05),there was significant difference in the highest value of PETCO2 between groupⅡand groupⅠ, groupⅢ(P<0.05).Funk sedetion score in groupⅡwas better than that in groupⅠand groupⅢ, and the difference was statistically significant(P<0.05). The awakening time in the groupⅠand groupⅡwas significantly shorter than that in the groupⅢ, and the satisfaction rate of mask induction in the groupⅡwas significantly higher than that in the groupⅢ(P<0.05). Conclusion: Intravenous injection of midazolam(0.08 mg/kg) before sevoflurane anesthesia in children has rapid effect, less postoperative awakening time, good safety and better sedation effect.