三种镇静剂对猫食管括约肌作用的比较。

Croffie J M, Ellett M L, Lou Q, Fitzgerald J F

Division of Gastroenterology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Dig Dis. 1999;17(2):113-20. doi: 10.1159/000016913.

BACKGROUND/AIMS: Children 5 years old and younger often require sedation for esophageal motility studies (EMS). At our institution, an intramuscular cocktail of meperidine, promethazine and chlorpromazine (MPC) has been used as the standard sedative for young children undergoing EMS. Administering the intramuscular sedative may, however, be more traumatic to the child than the procedure. Moreover, its effect on esophageal motility is not known and prolonged sedation is common. The aim of this study was to determine the effects of MPC and two orally-administered sedatives on esophageal sphincter function, using the cat model, with a goal to identify a potentially suitable orally-administered sedative for use in young children requiring sedation for EMS.

METHODS

We measured upper (UESP) and lower (LESP) esophageal sphincter pressures in 25 cats initially without sedation, and then following sedation with midazolam, chloral hydrate and MPC. The results were compared.

RESULTS

All three sedatives significantly decreased LESP compared to the control (p<0.05). Midazolam decreased LESP the most; however, the difference from the other sedatives did not reach statistical significance. All three sedatives decreased UESP, compared to control, but the differences were not statistically significant. Of the two oral sedatives, chloral hydrate had the least effect on the esophageal sphincters although its effect was not statistically different from that of midazolam.

CONCLUSIONS

Ethically appropriate studies are needed to determine which oral sedative would be most beneficial for use in sedating children undergoing esophageal motility studies. Until studies can be done, the choice between chloral hydrate and midazolam should be based on the experience and comfort of the attending physician with regard to the potential side effects of the medications.

背景/目的：5岁及以下儿童在进行食管动力研究（EMS）时通常需要镇静。在我们机构，哌替啶、异丙嗪和氯丙嗪的肌肉注射合剂（MPC）一直被用作接受EMS的幼儿的标准镇静剂。然而，肌肉注射镇静剂对儿童来说可能比该检查本身更具创伤性。此外，其对食管动力的影响尚不清楚，且长时间镇静很常见。本研究的目的是使用猫模型确定MPC和两种口服镇静剂对食管括约肌功能的影响，目标是确定一种可能适用于因EMS需要镇静的幼儿的口服镇静剂。

方法

我们在25只猫身上测量了食管上括约肌（UESP）和下括约肌（LESP）压力，首先在未镇静状态下测量，然后在使用咪达唑仑、水合氯醛和MPC镇静后测量。对结果进行比较。

结果

与对照组相比，所有三种镇静剂均显著降低了LESP（p<0.05）。咪达唑仑降低LESP的幅度最大；然而，与其他镇静剂的差异未达到统计学显著性。与对照组相比，所有三种镇静剂均降低了UESP，但差异无统计学显著性。在两种口服镇静剂中，水合氯醛对食管括约肌的影响最小，尽管其效果与咪达唑仑的效果无统计学差异。