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| 术前口服咪达唑仑对学龄前患儿疝囊高位结扎术后不良行为改变的影响 |
| Effect of preoperative oral midazolam solution on negative postoperative behavioral changes after high ligation of hernia sac in preschool children |
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| DOI：10.12089/jca.2024.11.010 |
| 中文关键词: 咪达唑仑 口服溶液 儿童 疝囊高位结扎术 术后不良行为改变 |
| 英文关键词: Midazolam Oral solution Children High ligation of hernial sac Negative postoperative behavioral changes |
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| 中文摘要: |
目的： 探讨术前30 min口服咪达唑仑对腹腔镜下行疝囊高位结扎术的学龄前患儿术后不良行为改变（NPOBCs）的影响。
方法： 选择2022年7月至2023年4月行腹腔镜下小儿疝囊高位结扎术的学龄前患儿197例，男118例，女79例，年龄1～6岁，BMI 14.0～24.5 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患儿分为两组：口服咪达唑仑组（M组，n=100）和口服糖盐水组（C组，n=97）。患儿由家属陪伴进入观察室，M组给予咪达唑仑0.5 mg/kg，C组给予5%糖盐水0.25 ml/kg，30 min后由“小丑”医师陪同进入手术室。记录入观察室前、入手术室前改良的耶鲁术前焦虑评分（m-YPAS）。记录麻醉诱导前诱导依从性检查表（ICC）评分。记录术后即刻、术后6、24 h儿童疼痛评估量表（FLACC）以及儿童苏醒期躁动评分量表（PAED）评分。记录术后恶心呕吐、低氧血症发生情况。于出院后1、7、14、30 d对患儿家属随访，采用儿童术后行为量表（PHBQ）评估NPOBCs发生情况。
结果： 与C组比较，M组入手术室前m-YPAS评分、麻醉诱导前ICC评分、术后即刻PAED评分、术后1、7、14、30 d NPOBCs发生率明显降低（P＜0.05）。两组入观察室前YPAS评分、术后6、24 h PAED评分、术后恶心呕吐和低氧血症发生率差异均无统计学意义。
结论： 腹腔镜下疝囊高位结扎术患儿术前30 min口服咪达唑仑可以有效缓解围术期焦虑情绪，降低NPOBCs发生率，且不增加患儿苏醒延迟及术后不良反应的发生风险。 |
| 英文摘要: |
Objective: To investigate the influence of oral midazolam on postoperative behavioral changes (NPOBCs) in preschool children undergoing laparoscopic inguinal hernia sac ligation.
Methods: A total of 197 preschool children, 118 males and 79 females, aged 1-6 years, BMI 14.0-24.5 kg/m2, ASA physical status Ⅰ or Ⅱ, who undergoing laparoscopic inguinal hernia sac ligation from July 2022 to April 2023 were selected. The children were divided into two groups by random number table method: the oral midazolam group (group M, n = 100) and the oral saline group (group C, n = 97). In the observation room, group M received an oral dose of 0.5 mg/kg midazolam while group C received an oral dose of 5% saline 0.25 ml/kg before being accompanied by a clown doctor to the operating room after 30 minutes. Modified Yale preoperative anxiety scale (m-YPAS) scores before entering the observation room and before entering the operating room, as well as induction compliance checklist (ICC) scores before anesthesia induction were recorded. Postoperatively, FLACC and PAED scores were recorded at immediately, 6, and 24 hours after surgery along with occurrences of postoperative nausea and vomiting and hypoxemia. Family members of the children were followed up at 1 day, 7, 14, and 30 days after discharge using PHBQ to record NPOBCs occurrence in children.
Results: Compared with group C, m-YPAS score, ICC score before anesthesia induction, PAED score immediately after surgery, and the incidence of NPOBCs 1 day, 7, 14, and 30 days after surgery were significantly reduced in group M (P < 0.05). There were no significant differences in YPAS scores before entering the observation room, 6 and 24 hours PAED scores, incidence of postoperative nausea and vomiting, hypoxemia between the two groups.
Conclusion: Preoperative oral administration of midazolam to children undergoing laparoscopic inguinal hernia sac ligation can effectively alleviate perioperative anxiety and reduce the incidence of NPOBCs. It does not increase the risk of delayed awakening or postoperative adverse reactions in children. |
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