镇静躁动评分在儿童支气管镜术前镇静中的应用

摘要

Objective To explore the application value of sedation-agitation scale (SAS) in broncoscopy in children by observing sedative drug dosage, adverse reactions and operator's satisfaction. Methods Children were divided into two groups, control group and SAS group, before broncoscopy. Midazolam was given a dose 0.10 ~ 0.30 mg/kg according to doctor's experience, without any assessment, while the SAS group were given an initial doses of Midazolam 0.10 mg/kg and then continued giving Midazolam until the SAS score reached 3 points to 4 points, but the maxium does less than 10 mg. The maxium dosage of Midazolam in both groups was less than 10 mg. Then compare the dosage and adverse reactions of Midazolam and operator's satisfaction between the two groups. Results 606 children were enrolled in the study, 364 were boys and 242 were girls. The age ranged from 1 month to 17 years, while the mean age was (3.97 ± 3.94) years. The body weights were from 2.4 kg to 56.0 kg, and the mean weight was (16.18 ± 10.65) kg. 301 children were included into control group and 305 children were included into SAS group. The gender composition, age range, department source and composition of the diseases of the two groups were compared, and the differences were not statistically significant. Compared with the control group, there was no severe adverse reaction such as respiratory depression or excessive sedation in the SAS group, and the average amount of Midazolam was lower than the dosage in control group [(0.21 ± 0.06) vs (0.26 ± 0.05) mg/kg];the intraoperative agitation, delirium, other adverse drug reactions and the number of involved in the operation, and operation time were reduced, while the differences were statistically significant. The operator's satisfaction is higher, but the difference was not statistically significant. Conclusions SAS can be used in assessment of conscious sedation level in children's bronchoscopy, and SAS can guide the individual use of Midazolam, reduce its dosage and adverse reactions,also can improve the operator's satisfaction during the operation. SAS is worthy of application in children's conscious sedation in bronchoscopy.%目的 观察儿童支气管镜检查中应用镇静躁动评分(SAS)后对镇静药物用量、不良反应及操作者满意度的影响,探讨SAS评分在儿童支气管镜检查中的应用价值.方法 采用回顾性对照研究,将接受支气管镜检查需要术前镇静的儿童分为对照组和SAS评分组,对照组患儿由医生根据经验一次性给予咪达唑仑,剂量0.10~0.30 mg/kg,最大剂量不超过10.0 mg,用药过程中不对患儿进行镇静状态的评估.SAS评分组患儿咪达唑仑剂量初始剂量为0.10 mg/kg,将静脉缓慢推注后,由医生进行SAS评分,并根据评分调整剂量,直至患儿评分达到3或4分(即安静合作至镇静状态).分别比较两组患儿咪达唑仑的用量和不良反应,包括术中躁动、谵妄、镇静过度和呼吸抑制等,将支气管镜检查的操作时间、参与操作人数及操作者满意度等操作体验情况进行比较,两组间均数比较用t检验,计数资料比较采用χ2检验,P <0.05为差异有统计学意义.结果 共纳入患儿606例,男364例,女242例;年龄1个月~17岁,平均(3.97±3.94)岁;体重2.4~56.0 kg,平均(16.18±10.65)kg.301例患儿分入对照组,305例患儿分入SAS评分组.比较两组患儿的性别构成、年龄分布、科室来源,差异均无统计学意义.两组患儿所患疾病均以肺炎合并肺不张为主.SAS组儿童未发生呼吸抑制、镇静过度等严重不良反应;与对照组比较,咪达唑仑用量(0.21±0.06)vs(0.26±0.05) mg/kg,用量较低,差异有统计学意义(P <0.05);术中躁动、谵妄等药物不良反应较少,参与操作人数减少,操作时间减少,差异有统计学意义(P <0.05);操作者满意度较高,但差异无统计学意义(P >0.05).结论 SAS评分应用于儿童支气管镜术的镇静评估,可指导咪达唑仑的个体化用药、在达到理想镇静效果的同时减少咪达唑仑的使用剂量、减少其不良反应,改善操作者体验,值得在儿童支气管镜检查中推广.