何小城　伍咏瑶　彭盛　何昀　罗威耀　刘志刚

【摘要】 目的：研究水合氯醛聯合咪达唑仑在小儿腰穿术中的镇静效果。方法：选取2017年1-12月佛山市妇幼保健院儿科246例行腰椎穿刺术的患儿，随机均分为三组，对照A组术前给予10%水合氯醛0.5 mL/kg口服，对照B组术前静注咪达唑仑0.2～0.3 mg/kg，观察组术前先予以10%水合氯醛0.5 mg/kg口服，30 min后静注咪达唑仑0.2～0.3 mg/kg，术中三组均用麻醉药物利多卡因进行皮肤局部浸润麻醉后进针。观察三组患儿的血氧饱和度、呛咳、憋气、喉痉挛、呼吸抑制情况和患儿苏醒后的镇定情况，评价药物镇静镇痛效果及穿刺成功率。结果：观察组呛咳、憋气、喉痉挛情况均明显优于对照A、B组（P<0.05）;对照A组患儿苏醒后的镇定情况显著低于对照B组和观察组（P<0.05）;三组血氧饱和度、呼吸抑制比较，差异无统计学意义（P>0.05）;观察组镇静总有效率显著高于对照A、B组，制动效果与穿刺成功率均优于对照A、B组，差异均有统计学意义（P<0.05）。结论：水合氯醛联合咪达唑仑应用于临床小儿腰穿术中的镇静镇痛效果显著，可提高穿刺成功率，具有推广的价值。

【关键词】 水合氯醛; 咪达唑仑; 儿童腰椎穿刺术; 镇静

【Abstract】 Objective：To study the sedative effects of Chloral Hydrate combined with Midazolam in lumbar puncture of children.Method：A total of 246 cases who underwent lumbar puncture in Pediatric Department of Foshan Maternal and Child Health Care Hospital from January to December 2017 were selected，they were randomly divided into three groups，the control group A was given 0.5 mL/kg of 10% Chloral Hydrate before operation，the control group B was pushed intravenous injection Midazolam 0.2-0.3 mg/kg before operation，before operation the observation group was given 10% Chloral Hydrate 0.5 mg/kg，oral，after 30 min pushed intravenous injection of 0.2-0.3 mg/kg of Midazolam.Three groups were administered by the anesthetic drug Lidocaine to get a partial injection of the skin to the epitope.The blood oxygen saturation，cough，choking，laryngeal spasm，respiratory depression and the state of composure after resuscitation of three groups were observed，the sedative and analgesic effects and the success rate of puncture were evaluated.Result：The cough，choking and laryngeal spasm of the observation group were significantly better than those of the control group A and control group B（P<0.05）.The calmness after resuscitation in the control group A was significantly lower than those of the control group B and the observation group（P<0.05）.There were no differences among three groups in oxygen saturation and respiratory depression（P>0.05）.The total sedation efficiency of the observation group was higher than those of the control group A and B（P<0.05）.The braking effect and puncture success rate of the observation group were better than those of the control group A and B（P<0.05）.Conclusion：Chloral Hydrate combined with Midazolam have a significant effect on sedation and analgesic in lumbar puncture of children，and can improve the success rate of puncture，it has a value of promoting it.

【Key words】 Chloral hydrate; Midazolam; Lumbar puncture in children; Sedation

First-authors address：Southern Medical University Affiliated Foshan Maternal and Child Health Care Hospital，Foshan 528000，China

doi：10.3969/j.issn.1674-4985.2019.08.040

小兒腰椎穿刺术（LP）是神经内科常用的诊疗操作之一，是指用腰穿针从腰椎间隙穿入腰池，测定脑脊液压力，收集脑脊液进行临床检测并诊断疾病的技术[1]。但是反复多次的腰椎穿刺带来的疼痛，导致患儿恐惧情绪甚至拒绝配合治疗[2]，因此腰穿术中对患儿镇静镇痛的环节渐被患儿家长及医务人员重视。水合氯醛作为常用催眠药、抗惊厥药[3]，儿童在口服给药或灌肠给药10～30 min后起镇静催眠作用，快速起效使患儿入眠，且醒后无不适感[4];咪达唑仑是一种苯二氮类中枢神经抑制药，在术前通过静脉推注给药，起效迅速，用药2～5 min后镇静效果达到峰效应，可维持效果45～60 min[5-6]。……