口服不同剂量咪达唑仑对腹腔镜腹股沟斜疝疝囊高位结扎术患儿术前焦虑的影响

Effect of different oral dosage of midazolam on anxiety before laparoscopic high ligation of the hernia sac in children with oblique inguinal hernia

中文关键词: 咪达唑仑  儿童  术前焦虑  腹腔镜  腹股沟斜疝

英文关键词: Midazolam  Children  Preoperative anxiety  Laparoscopy  Inguinal hernia

中文摘要:

      
目的： 观察口服不同剂量咪达唑仑用于缓解腹腔镜腹股沟斜疝疝囊高位结扎术患儿术前焦虑的效果。
方法： 选择择期在全麻下行腹腔镜腹股沟斜疝疝囊高位结扎术的患儿120例，男93例，女27例，年龄2～6岁，身高78～120 cm，体重11～25 kg,ASA Ⅰ或Ⅱ级。采用随机数字表法将患儿分为三组：麻醉前30 min口服咪达唑仑0.25 mg/kg组(M1组)、0.5 mg/kg(M2组)和0.75 mg/kg(M3组)，每组40例。记录服药前、与父母分离时、麻醉诱导即刻简化版改良耶鲁术前焦虑量表(mYPAS-SF)评分和麻醉诱导期合作度量表(ICC)评分。记录苏醒时间、拔管时间、PACU停留时间、术后30 min 儿童麻醉苏醒期躁动量表(PAED)评分和改良面部表情疼痛量表(FLACC)评分。
结果： 与服药前比较，M2组和M3组在与父母分离时、麻醉诱导即刻mYPAS-SF评分明显降低(P<0.05)。与M1组比较，M2组和M3组与父母分离时、麻醉诱导即刻mYPAS-SF明显降低(P<0.05)，麻醉诱导即刻ICC评分明显降低(P<0.05)，苏醒时间、拔管时间和PACU停留时间明显延长(P<0.05)，术后30 min PAED评分明显降低(P<0.05)。与M2组比较，M3组苏醒时间和拔管时间明显延长(P<0.05)。
结论： 麻醉前30 min口服咪达唑仑0.5 mg/kg或0.75 mg/kg均可有效缓解患儿术前焦虑，提高麻醉诱导合作度，降低术后躁动的发生，口服咪达唑仑0.75 mg/kg的患儿苏醒时间和拔管时间延长，因此，口服咪达唑仑0.5 mg/kg为患儿术前抗焦虑方案比较合适的剂量。

英文摘要:

      
Objective: To observe the efficacy of different dosage of midazolam oral solution in relieving anxiety in children undergoing laparoscopic high ligation of the hernia sac with oblique inguinal hernia.
Methods: A total of 120 children, 93 males and 27 females, aged 2-6 years, 78-120 cm in height and 11-25 kg in weight, ASA physical status Ⅰ or Ⅱ, were selected to perform laparoscopic high ligation of inguinal oblique hernia sac under general anesthesia. According to random number table method, the children were divided into three groups: the oral midazolam 0.25 mg/kg group (group M1), 0.5 mg/kg group (group M2), and 0.75 mg/kg group (group M3) 30 minutes before anesthesia, 40 children in each group. Modified Yale preoperative anxiety scale-short form (mYPAS-SF)was recorded at premedication, parental separation, and immediate induction of anesthesia. Induction compliance checklist (ICC) score, recovery time, extubation time, PACU residence time, pediatric anesthesia emergence delirium scale (PAED) and the modified face, legs, activity, cry and consolability scale (FLACC) 30 minutes after operation were also recorded.
Results: Compared with before taking medication, mYPAS-SF scores in groups M2 and M3 at parental separation and immediate induction of anesthesia were significantly decreased (P < 0.05). Compared with group M1, mYPAS-SF scores at parental separation and immediate induction of anesthesia and ICC scores at immediate induction of anesthesia were significantly lower in groups M2 and M3 (P < 0.05), the recovery time, extubation time and PACU resident time in groups M2 and M3 were significantly prolonged, PAED score was decreased significantly within 30 minutes after operation (P < 0.05). Compared with group M2, the awakening time and extubation time in group M3 were significantly prolonged. (P < 0.05).
Conclusion: Oral midazolam 0.5 mg/kg or 0.75 mg/kg 30 minutes before anesthesia can effectively alleviate the preoperative anxiety of children, improve the degree of cooperation in anesthesia induction, and reduce the occurrence of postoperative agitation, the recovery time and extubation time prolonged in children with oral midazolam 0.75 mg/kg. Therefore, an oral solution of midazolam 0.5 mg/kg was a more appropriate dose for preoperative antianxiety regimen in children.