咪达唑仑静脉注射对儿童埋伏多生牙拔除术中镇静效果的临床评价  

Clinical evaluation of midazolam intravenous sedation under bispectral index monitoring on romoval of anterior supernumerary teeth in children

作　　者：关明[1] 王恩博[1] 刘宇[1] 崔念晖[1] 丁蓓[1] 张伟[1] 

机构地区：[1]北京大学口腔医学院·口腔医院口腔颌面外科,北京100081

出　　处：《北京大学学报（医学版）》2012年第1期120-124,共5页Journal of Peking University:Health Sciences

摘　　要：目的:旨在评估咪达唑仑静脉镇静联合局部麻醉拔除儿童上颌埋伏多生牙的镇静效果及其安全性。方法:选择在北京大学口腔医院牙科门诊拔除上颌埋伏多生牙的患儿(6～14岁)41名,美国麻醉医师协会(AmericanSociety of Anesthesiology,ASA)分级Ⅰ级,咪达唑仑静脉滴定到中度镇静,在局部麻醉下进行手术,记录患儿入室5min(作为基础值)、局部麻醉时、手术切开时、手术10 min、手术结束时的心率(heart rate,HR)、血压(blood pres-sure,BP)、脉搏氧饱和度(pulse oxygen saturation,SpO2)、呼吸频率(respiratory rate,RR)、脑电双频指数值(bispectralindex,BIS)和Ramsay镇静评分(Ramsay sedation score,RSS),手术结束后评价治疗的总体镇静效果。结果:41名儿童中男29名、女12名,年龄(9.76±2.46)岁,手术时间为(23.83±9.98)min,用药总量为(2.96±0.92)mg,用药剂量为(0.084±0.016)mg/kg。年龄与用药总量呈显著正相关(r=0.69,P<0.01),与用药剂量之间呈明显负相关(r=-0.37,P<0.05);随着年龄减小,患儿在局部麻醉时发生体动或哭泣的概率增大;随着年龄增加,患儿对牙钻或锤敲击有记忆的概率增大;RSS和BIS值相关系数为r=-0.854(P<0.01),RSS为3时对应的BIS值中位数是75;所有患儿均完成手术且术中的SpO2在95%以上。结论:在儿童上颌埋伏多生牙拔除术中,采用咪达唑仑滴定法静脉镇静,使患儿处于嗜睡、反应迟钝状态,且BIS值不低于75是安全有效的。Objective： To evaluate the efficacy and safety of midazolam intravenous sedation plus local anaesthesia on romoval of children＇s anterior supernumerary teeth in dental clinic.Methods： A total of 41 ASAⅠchildren with anterior supernumerary teeth aged 6 to 14 were selected for removal surgery,anaesthesia was done by moderate sedation by midazolam intravenous titration plus local anaesthesia.Heart rate（HR）,blood pressure（BP）,pulse oxygen saturation rate（SpO2）,bispectral index（BIS） and Ramsay sedation score（RSS） at different time points were recorded（5 min after patient is in operation room,at local anaesthesia injection,at incision,10 min after incision and at the end of operation）.After operation,the overall efficacy of sedation by Houpt rating scale was evaluated by surgeon,anaesthesiologist and anaesthetic nurse.Results： Among the 41 children,29 were male,12 were female,mean age（9.76±2.46） years old;The average operation time was（23.83±9.98） min,total dose of midazolam was（2.96±0.92） mg with a dosage rate being（0.084±0.016） mg/kg.There was a positive correlation between age and total dose（r=0.69,P0.01）;and a negative correlation between age and total dosage（r=-0.37,P0.05）.With the decreasing of age,probability for children to move or cry during local anaesthesia can increase,while with the increasing of age,probability for children to memorize the clicking of drill or hammer could increase.The correlation coefficient between RSS and BIS value was r=-0.854（P0.01）,the median BIS value corresponded to RSS of 3 was 75.Pulse oxygen saturation rate was above 95% in all the cases.Conclusion： Sedation by midazolam intravenous titration is a safe and efficient method of anesthesia for removal of children＇s anterior supernumerary teeth when BIS value is above 75.

关 键 词：拔牙 咪达唑仑 输注 静脉内 儿童 

分 类 号：R782.11[医药卫生—口腔医学]