无痛无创技术应用于小儿静脉麻醉诱导的临床观察  

Clinical observation on the application of painless and non-invasive technology in induction of intravenous anesthesia for pedicatric patients

作　　者：孙东燕 杨儒宸 姜雪丽 张林语 角院桃 SUN Dongyan;YANG Ruchen;JIANG Xueli;ZHANG Linyu;JIAO Yuantao(Department of Anesthesiology,Dali Prefeature Maternal and Child Health Care Hospital,Dali 671000,China)

机构地区：[1]大理州妇幼保健院麻醉科,云南大理671000

出　　处：《麻醉安全与质控》2024年第6期322-326,共5页Perioperative Safety and Quality Assurance

摘　　要：目的观察儿童艾司氯胺酮复合咪达唑仑口服术前镇静治疗+丁卡因凝胶穿刺静脉经皮局麻无痛无创静脉诱导的临床效果。方法选取2022-09/2023-04期间大理州妇幼保健院腹股沟区短小手术患儿共120例,其中幼儿组(1-3岁)60例,学龄前儿童组(<3-7岁)60例,由麻醉护士抽签将幼儿组及学龄前儿童组内分别随机分为对照组(n=30)和观察组(n=30)。对照组不实施术前镇静治疗及丁卡因凝胶经皮局麻;观察组丁卡因凝胶经皮局麻穿刺静脉,艾司氯胺酮注射液1.5 mg/kg+咪达唑仑口服液0.5 mg/kg混合口服术前镇静。观察并记录患儿进入手术室等候区即刻(T_(1))及进入手术间即刻(T 2)的改良耶鲁术前焦虑量表评分(m-YPAS),观察亲子分离情况、静脉穿刺接受情况、丙泊酚诱导接受情况、苏醒后躁动情况及有无并发症。结果幼儿组T_(1)时刻的m-YPAS评分明显高于学龄前儿童组,差异有统计学意义(P<0.05);幼儿对照组T 2时刻m-YPAS评分高于T_(1)时刻,差异有统计学意义(P<0.05);幼儿及学龄前儿童观察组T_(2)时刻m-YPAS评分低于T_(1)时刻,差异有统计学意义(t=3.099、4.852,P<0.05)。幼儿及学龄前儿童观察组与对照组相比较静脉穿刺接受度及丙泊酚诱导接受度明显提高;幼儿观察组与对照组相比较亲子分离评分及苏醒期躁动评分明显降低,差异有统计学意义(P<0.05)。结论艾司氯胺酮复合咪达唑仑口服术前镇静治疗抗焦虑效果好,能提高患儿对于诊疗的配合程度,复合丁卡因凝胶穿刺静脉局麻后,能提高静脉穿刺的接受度,能安全舒适实施无痛无创静脉麻醉诱导。Objective To investigate the clinical effect of preoperative sedation treatment with esketamine combined with midazolam,and painless and non-invasive intravenous induction of tetracaine gel for local anesthesia.Methods A total of 120 children,including 60 toddlers(1-3 years old)and 60 preschool children(<3-7 years old),undergoing short surgery in the inguinal region in Dali Prefeature Maternal and Child Health Care Hospital from September 2022 to April 2023,were selected.The toddlers and preschool children were randomly divided into the control group(n=30)and the observation group(n=30),respectively.The control group didn t receive preoperative sedation treatment,and hand cream was applied to puncture vein;a mixture of 1.5 mg/kg of esketamine injection and 0.5 mg/kg of midazolam oral solution were administrated to the observation group;vein puncture was performed under local anesthesia with tetracaine gel.The modified Yale Preoperative Anxiety Scale score(the modified Yale Preoperative Anxiety Scale,m-YPAS)immediately after the patient enters the waiting area of the operating room(T_(1))and immediately after entering the operating room(T_(2))were recorded;the situation of parent-child separation into the operating room,the acceptance of venous puncture,the induction of propofol acceptance,the restlessness after awakening,and the presence or absence of complications were observed.Results The m-YPAS score at T_(1)in the toddler group was significantly higher than that in the preschool children group(P<0.05),the m-YPAS score at T_(2)in the control group was significantly higher than that at T_(1)(P<0.05),and the m-YPAS score of the toddler group and the preschool group at T_(2)was significantly lower than those at T_(1)(t=3.099,4.852,P<0.01).The acceptance of venipuncture and propofol induction in the observation group were significantly higher than those in the control group,while the scores of parent-child separation and restlessness in the recovery period in the study group were significantly lower than those in

关 键 词：艾司氯胺酮复合咪达唑仑口服术前镇静 丁卡因凝胶穿刺静脉局麻 无痛无创技术 小儿静脉麻醉诱导 

分 类 号：R726.1[医药卫生—儿科]