水合氯醛和咪达唑仑用于儿科门诊镇静的给药途径研究

目的:优选儿科门诊应用水合氯醛和咪达唑仑镇静的给药途径。方法:选择需镇静的门诊患儿120例,随机分为水合氯醛口服组、水合氯醛灌肠组、咪达唑仑肌肉注射组、咪达唑仑滴鼻组各30例并以相应方法进行镇静,记录并比较镇静深度、起效时间、持续时间、Ramsay评分、一次成功率和不良反应。结果:咪达唑仑滴鼻组与咪达唑仑肌肉注射组比较,起效时间差异无统计学意义(P>0.05),但持续时间较长(P<0.05)。水合氯醛灌肠组与水合氯醛口服组比较,起效时间较短、持续时间较长、Ramsay评分<3分的患儿较少(P均<0.05)。四组患儿镇静一次成功率比较差异无统计学意义(P均>0.05)。患儿在镇静期间均未发生严重不良反应。咪达唑仑肌肉注射组出现低氧合和呼吸抑制,咪达唑仑滴鼻组均未出现,且心血管抑制发生率较低(P<0.05)。水合氯醛灌肠组恶心呕吐发生率低于水合氯醛口服组(P<0.05)。结论:儿科门诊应用水合氯醛灌肠、咪达唑仑滴鼻进行镇静,效果较好,不良反应较少,安全性较高。

Multiple Routes of Administration on the Sedation of Pediatric Outpatient Department

Objective: To investigate the effect of multiple routes of administration on the sedation of pediatric outpatient department. Methods: One hundred and twenty outpatient children who needed sedation therapy were randomly divided into four groups: oral chloral hydrate group, chloral hydrate administrated rectally group, intramuscular injection of midazolam group and midazolam drop nose group. The depth of sedation, the onset time and duration time of sedation, the Ramsay, the successful rate of first sedated, the rate of adverse reactions during the period of sedation were compared. Results: There was no significant difference in the onset time of sedation in intramuscular injection of midazolam group and midazolam drop nose group (P>0.05), but the duration time of sedation in midazolam drop nose group was much longer (P<0.05). Compared with the oral chloral hydrate group, the onset time was shorter, duration time of sedation was longer, the children with Ramsay<3 were less in chloral hydrate administrated rectally group (P<0.05). There were no significant differences in the one-time success sedation rates in the four groups (P>0.05). The intramuscular injection of midazolam group had low oxygenation and respiratory depression, these were not occur in the midazolam drop nose group, and the incidence rate of cardiovascular inhibition were lower (P<0.05). The incidence of nausea and vomiting was significantly higher in oral chloral hydrate group than the chloral hydrate administrated rectally group (P<0.05). Conclusion: Chloral hydrate administrated rectally and midazolam nasal drip in pediatric outpatient can provide effective sedation with less adverse reactions, and high efficiency.