可乐定及咪唑安定作为小儿术前用药的比较  

Comparison between clonidine and midazolam as premedication in children

作　　者：马长松[1] 李水红[1] 陈帅[1] 周洁贤[1] 王宏[1] 

机构地区：[1]广东省珠海市妇幼保健院,519000

出　　处：《中国妇幼保健》2005年第16期2088-2091,共4页Maternal and Child Health Care of China

摘　　要：目的:使用前瞻性、随机化、双盲设计,比较可乐定(Clonidine)及咪唑安定(Midazolam)术前用药的效果.方法:将100名择期进行包皮环切术的患儿,ASA身体状态1级(年龄1～11岁),在进行标准的氨氟醚麻醉之前随机分为2组,M组(n=52)给予咪唑安定300 μg/kg及阿托品40 μg/kg;C组(n=52)可乐定5 μg/kg及阿托品40μg/kg;均通过直肠术前用药.选择目标疼痛评分(OPS)评价术后解疼痛的发生率(0～2 h),镇静程序使用Vancouver镇静评分(0～3分).术后对患儿进行24 h疼痛、镇静、术后呕吐的发生率(POV)及睡眠方式评价,并要求家长对孩子术后表现进行观察并行问卷调查(安静、镇静及警醒、活跃).结果:C组术后(中位数=8.0)5种OPS积分之和较M组(中位数=11.5)显著降低(P=0.011).与接受咪唑安定(中位数=12)的儿童相比,C组术后早期镇静积分总和(中位数=13)较M组轻度增高(P＜0.01).M组中有5位患儿出现震颤而C组没有出现震颤现象(P=0.057).在年龄较小的患者中(＜5岁),C组术后意识模糊的发生率比M组低(P=0.001).术后第1个24h,在家长评估的呕吐发生率、术后疼痛程度、对镇痛药的需要及睡眠方式等两组间没有差异,C组安静及镇静程度强于M组(P=0.024).结论:可乐定直肠用药与咪唑安定相比可明显减轻术后早期疼痛,术后24h内使患儿获得中度镇静.Objective： To compare effect of clonidine and midazolam as premedication using a prospective, randomized and double -blind design. Methods： 100 children patients scheduled for circumcision with ASA physical status 1 grade （aged 1 - 11 years） were divided at random M group （n =52） received midazolam 300 μg/kg and atropine 40μg/kg and C group （n =48） received clonidine 5 μg/kg and atropine 40 μg/kg, both groups given rectal application. The incidence of immediate postoperative pain （0 -2 h） was assessed by repeated Objective Pain Scale （OPS） scores. Degree of sedation （ modified Vancouver sedation scale 0 - 3 ）, occurrence of postoperative vomiting （POV） , and incidence of shivering and immediate postoperative confusion was registered as end - points. Parents were instructed to continue the evaluation of pain, sedation, POV and sleep during a 24 - h period. Parents were also asked for their preference concerning the postoperative behavior of their child （calm, sedated, VS alert, active） . Results： OPS scores （median =8.0） in C group significantly decreased than that of M group M （ median = 11.5 ） （ P = 0. 011 ） . Early postoperative sedation score （ median = 13 ） in C group slightly increased than that of M group （median = 12） （P 〈0. 01 ） . No episode of shivering was observed in the C group but was present in five of the patients in M group （ P = 0. 057 ） . In younger children （ 〈 5 years）, the incidence of postoperative confusion was lower in C group than that in M group （ P = 0. 001 ） . No difference in the frequencies of POV incidences, need for analgesic and sleep mode of postoperative hours could be observed between two groups according to parents＇evaluation in the first 24 hours, the calm and sedated degree in C group were better than those in M group （P = 0. 024） . Conclusion： Rectal premedication with clonidine could significantly reduce postoperative early pain comparing to midazolam with moderately increased sedatio

关 键 词：镇痛 可乐定 咪唑安定 术后 术前用药 镇静 

分 类 号：R726[医药卫生—儿科]