儿科镇静的安全问题  

Safety Issues of Pediatric Sedation

作　　者：金立红 陈煜[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,上海200127

出　　处：《麻醉与监护论坛》2011年第5期390-393,共4页Forum of Anesthesia and Monitoring

摘　　要：随着麻醉与诊疗技术的发展与提高，住院及非住院患儿手术室外的诊疗操作日益增多．此过程的镇静需求也随之增加。患儿在使用镇静药物后意识程度降低．同时保护性反射功能也被削弱，镇静风险随镇静深度的增加而增高。镇静用药的不规范和镇静过程监护不足等原因，均可使儿科镇静面临潜在的危险．诸如通气不足、气道阻塞、喉痉挛以及心肺功能受损等．严重者引起呼吸暂停、中枢神经系统永久性损伤甚至死亡。为规范儿科镇静技术．提高镇静的安全性和有效性，美国儿科牙科学会（AAPD）和美国麻醉医师学会（ASA）共同制定了儿科镇静指南。并经不断修订而逐步完善。但目前国内外在如何规范化实施儿科镇静方面仍存在颇多争议．如镇静患儿是否需要禁食？如何制定个体化镇静用药？等等。儿科镇静的安全实施．需要完善镇静人员的资质认定和专业培训．需要配备相应的急救设施．需要完善镇静前评估并加强全程监测和统一离院标准。With the development of anesthesia and sedation, sedation techniques are more demanding as a result of increasing medical diagnosis or therapeutic procedure for inpatients and outpatients outside the operation. Sedative medicine can weaken the level of consciousness and impair protective reflex of pediatric patients, so the deeper sedation is, the more dangerous it is. Sedation for pediatric patients has potential risks, such as hypoventilation, airway obstruction, apnea and cardiopulmonary impairment due to operators＇ error or lack of monitoring. It can sometimes cause more serious results, such as permanent damage to central nervous system, or even death. In order to standardize the sedation for pediatric patients and increase its safety and effectiveness, the American Academic of Pediatric Dentisty （AAPD） and American Society of Anesthesiology （ASA） published a series of guidelines for monitoring and management of sedation which have been revised and improved gradually. However, there are still many arguments on the standardization of sedation practice, for examples, whether a sedated pediatric patient needs fasting and how to personalize sedative medicine. Safe sedation depends on qualified personnel, professional training for staff, proper rescue equipments, perfect evaluations before sedation, enhanced monitoring during the whole sedation process and unified discharge standard.

关 键 词：儿科镇静 规范化 安全 有效 

分 类 号：R971.3[医药卫生—药品]