摘要
目的观察咪达唑仑减轻七氟烷全麻下小儿咽喉部手术后躁动的临床效果和安全性。方法选择60例4～12y在全麻下行扁桃体和腺样体摘除择期手术符合入选标准的患儿。随机分为咪达唑仑组(Ⅰ组,n=30)和对照组(Ⅱ组,n=30),入手术室后所有患者面罩直接吸纯氧(1L/min)加七氟烷,逐步升高七氟烷的吸入浓度(最大浓度为7%),直至患儿睫毛反射消失,用维库溴胺0.1mg/kg诱导后行气管内插管,维持七氟烷浓度控制在4.0%以下。Ⅰ组手术结束前15min咪达唑仑0.3mg/kg直肠注入,Ⅱ组给予等体积生理盐水。术中监测平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、VAS镇痛评分、Ramsay镇静评分及不良反应,观察术后躁动发生率和躁动程度。结果 (1)Ⅰ组患者术后躁动发生率明显低于Ⅱ组,Ⅱ组患者术后中、重度躁动多见(P<0.05)。(2)与Ⅰ组相比,Ⅱ组患者术后MAP、HR明显增高(P<0.01)。(3)Ⅰ组患者术后Ramsay评分明显低于Ⅱ组(P<0.O1),2组VAS评分差异无显著性(P>0.05)。(4)2组患者术后呕吐发生率均<5%,无呼吸抑制发生。结论手术结束前15min咪达唑仑O.3mg/kg可减轻七氟烷全麻下小儿咽喉部手术后躁动。
Objective To observe the clinical effects and satety of midazolam by rectal instillation for reducing the occurrence of postoperative agitation in children undergoing throat surgery with sevoflurane general anesthesia. Methods A total of 60 pediatric patients （4 ~ 12 y old） undergoing throat surgery were randomly divided into midazolam group （group I, n =30） and control group （group Ⅱ, n=30）. All the patients inhaled 100% oxygen （1 L/min） and sevoflurane by mask, and the concentration of sevoflurane was gradually increased （the maximum concentration 7% ） until the lash reflex disappeared, then the endotrachael intubation was carried out after the patients were given vecuronium 0.1 mg/kg. The maintenance concentration was controlled under 4%. Patients in group I were given midazolam 0.3 mg/kg by rectal instillation 15 min before the conclusion of the operation, while patients in group Ⅱ was given an equal volume of NS. The mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpO2）, VAS score, and Ramsay sedation score were assessed during the anesthesia. The incidence of adverse reactions, postoperative agitation, nausea and vomiting were observed and recorded. Results The incidence of agitation in patients of group I was remarkably lower than those of group Ⅱ （P 〈 0.05 ）. The HR and MAP of patients in group Ⅱ was significant higher than those in group I （ P 〈 0.01 ）. The Ramsay sedation score of patients in group I was significantly lower than those of group Ⅱ （P 〈 0.01 ）. There was no significant difference in the VAS score between 2 groups. There was no significant difference in the incidence of vomiting in 2 groups, both were lower than 5%. Conclusion Treated with midazolam 0. 3 mg/kg 15 rain before the conclusion of operation by rectal instillation can reduce the incidence of postoperative agitation in children undergoing throat surgery with sevoflurane general anesthesia.
出处
《今日药学》
CAS
2010年第6期54-56,共3页
Pharmacy Today
关键词
咽喉部手术
咪达唑仑
七氟烷
小儿
术后躁动
throat surgery
midazolam
sevoflurane
children
postoperative agitation
