咪达唑仑作为一种短效苯二氮卓类镇静剂,起效迅速且恢复快,在临床上得到广泛应用,特别是在儿童程序性镇静领域。咪达唑仑存在剂量依赖性的呼吸抑制,这使得临床医生在选择镇静方案时需要充分评估患者的具体情况。此外,咪达唑仑单独使用...咪达唑仑作为一种短效苯二氮卓类镇静剂,起效迅速且恢复快,在临床上得到广泛应用,特别是在儿童程序性镇静领域。咪达唑仑存在剂量依赖性的呼吸抑制,这使得临床医生在选择镇静方案时需要充分评估患者的具体情况。此外,咪达唑仑单独使用时效果不佳,临床上常与其他镇静药物联合使用,如与丙泊酚、右美托咪定、氯胺酮等联合使用,能够在保证镇静深度的同时,减少较大剂量的单一药物可能引起的不良反应。本文将系统综述咪达唑仑在儿童程序性镇静中的研究进展,探讨其临床应用中的优势与挑战,为进一步的研究和临床实践提供指导。Midazolam, a short-acting benzodiazepine sedative, acts rapidly and has a quick recovery time, making it widely used in clinical practice, particularly in pediatric procedural sedation. Midazolam has a dose-dependent respiratory depressant effect, which requires clinicians to carefully assess the patient’s specific condition when selecting a sedation regimen. Additionally, midazolam is less effective when used alone, and is often combined with other sedative drugs in clinical practice, such as propofol, dexmedetomidine, and ketamine. This combination can ensure adequate sedation depth while minimizing the adverse effects associated with higher doses of a single drug. This article systematically reviews the research progress of midazolam in pediatric procedural sedation, discussing its advantages and challenges in clinical applications, and providing guidance for further research and clinical practice.展开更多
迄今为止,术后恶心呕吐(postoperative nausea and vomiting, PONV)仍然是围术期间严重的并发症之一,它增加了患者手术切口破裂,出血的风险并可能导致吸入性肺炎,电解质紊乱,脱水等不良事件的发生,增加了患者的住院时间以及费用,在一定...迄今为止,术后恶心呕吐(postoperative nausea and vomiting, PONV)仍然是围术期间严重的并发症之一,它增加了患者手术切口破裂,出血的风险并可能导致吸入性肺炎,电解质紊乱,脱水等不良事件的发生,增加了患者的住院时间以及费用,在一定程度上影响了患者术后的生活品质。预防术后恶心呕吐仍然是临床上热议的话题之一,特别是预防儿童术后恶心呕吐更应该得到大众的关注。这篇文章综述了最近几十年对于预防儿童PONV的研究进展的总结。To date, postoperative nausea and vomiting (PONV) is still one of the serious complications during perioperative surgery, which increases the risk of surgical incision rupture and bleeding and may lead to aspiration pneumonia, electrolyte imbalance, dehydration and other adverse events, increases the length of hospital stay and costs, and affects the quality of life of patients after surgery to a certain extent. The prevention of postoperative nausea and vomiting is still one of the hot topics in clinical practice, especially the prevention of postoperative nausea and vomiting in children should receive more public attention. This article summarizes recent advances in research on the prevention of PONV in children.展开更多
目的:观察右美托咪定复合静脉全身麻醉用于小儿纤支镜检查的临床效果。方法:选择拟行纤支镜检查术的1~3岁患儿80例,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级,随机分为2组(n=40):生理盐水组(NS组)...目的:观察右美托咪定复合静脉全身麻醉用于小儿纤支镜检查的临床效果。方法:选择拟行纤支镜检查术的1~3岁患儿80例,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级,随机分为2组(n=40):生理盐水组(NS组)和右美托咪定组(Dex组)。所有患儿检查前均雾化吸入2%盐酸利多卡因,Dex组于麻醉诱导前10 min静脉给予1μg/kg负荷剂量的右美托咪定,NS组给予同等剂量的生理盐水。所有患儿均采用静脉复合全身麻醉,保留自主呼吸鼻咽通气道给氧。分别记录麻醉后纤支镜进入前(T1)、进镜至咽部(T2)、进入声门(T3)、抵达隆突(T4)及第10分钟(T5)时的心率(heart rate,HR)、呼吸频率(respiration rate,RR)和无创平均动脉血压(mean artery blood pressure,MAP)、动脉血氧饱和度(blood oxygen saturation,SpO2)。观察纤支镜检查期间有无呛咳、体动、声门痉挛、气道痉挛、严重缺氧、心肺复苏等不良事件的发生;记录患儿检查时间及苏醒时间,追加全身麻醉药的次数和剂量,离开手术室时小儿麻醉苏醒期躁动评分(pediatric anesthesia emergence delirium scale,PAED)及患者满意度。结果:2组患儿一般情况无统计学差异(P>0.05)。与T1比较,NS组T2、T3、T4及T5的MAP和T2、T3、T4的HR明显升高,Dex组在T4时MAP明显升高(P<0.05)。与NS组比较,Dex组T2、T3、T4及T5的MAP和T2、T3、T4的HR均明显降低(P<0.05);使用丙泊酚和舒芬太尼的剂量以及追加次数明显减少,不良事件发生率降低,检查时间和苏醒时间明显缩短(P<0.05);离室时PAED评分明显降低(P<0.05);2组患者满意度无统计学差异(P>0.05)。结论:右美托咪定可安全用于静脉全身麻醉在婴幼儿纤支镜检查治疗且效果良好,获得更稳定的生命体征,减少全身麻醉药的用量,并降低术中不良事件的和术后躁动的发生率,缩短检查和苏醒时间。展开更多
文摘咪达唑仑作为一种短效苯二氮卓类镇静剂,起效迅速且恢复快,在临床上得到广泛应用,特别是在儿童程序性镇静领域。咪达唑仑存在剂量依赖性的呼吸抑制,这使得临床医生在选择镇静方案时需要充分评估患者的具体情况。此外,咪达唑仑单独使用时效果不佳,临床上常与其他镇静药物联合使用,如与丙泊酚、右美托咪定、氯胺酮等联合使用,能够在保证镇静深度的同时,减少较大剂量的单一药物可能引起的不良反应。本文将系统综述咪达唑仑在儿童程序性镇静中的研究进展,探讨其临床应用中的优势与挑战,为进一步的研究和临床实践提供指导。Midazolam, a short-acting benzodiazepine sedative, acts rapidly and has a quick recovery time, making it widely used in clinical practice, particularly in pediatric procedural sedation. Midazolam has a dose-dependent respiratory depressant effect, which requires clinicians to carefully assess the patient’s specific condition when selecting a sedation regimen. Additionally, midazolam is less effective when used alone, and is often combined with other sedative drugs in clinical practice, such as propofol, dexmedetomidine, and ketamine. This combination can ensure adequate sedation depth while minimizing the adverse effects associated with higher doses of a single drug. This article systematically reviews the research progress of midazolam in pediatric procedural sedation, discussing its advantages and challenges in clinical applications, and providing guidance for further research and clinical practice.
文摘迄今为止,术后恶心呕吐(postoperative nausea and vomiting, PONV)仍然是围术期间严重的并发症之一,它增加了患者手术切口破裂,出血的风险并可能导致吸入性肺炎,电解质紊乱,脱水等不良事件的发生,增加了患者的住院时间以及费用,在一定程度上影响了患者术后的生活品质。预防术后恶心呕吐仍然是临床上热议的话题之一,特别是预防儿童术后恶心呕吐更应该得到大众的关注。这篇文章综述了最近几十年对于预防儿童PONV的研究进展的总结。To date, postoperative nausea and vomiting (PONV) is still one of the serious complications during perioperative surgery, which increases the risk of surgical incision rupture and bleeding and may lead to aspiration pneumonia, electrolyte imbalance, dehydration and other adverse events, increases the length of hospital stay and costs, and affects the quality of life of patients after surgery to a certain extent. The prevention of postoperative nausea and vomiting is still one of the hot topics in clinical practice, especially the prevention of postoperative nausea and vomiting in children should receive more public attention. This article summarizes recent advances in research on the prevention of PONV in children.
