McCann W, Wilson S, Larsen P, Stehle B
Pediatric Dentistry Residency Program, Ohio State University, Columbus, USA.
Pediatr Dent. 1996 Jan-Feb;18(1):35-41.
The purpose of this study was to determine differences in heart rate (HR), blood pressure (BP), peripheral oxygen saturation (pO2), expired CO2 (CO2), and behavior (using two scales) comparing nitrous oxide/oxygen (N2O) with oxygen (O2) alone in 20 children (mean age 45 +/- 5.1 months) sedated with chloral hydrate (CH) and hydroxyzine in a double-blind crossover design. Administration of CH (40 mg/kg) and hydroxyzine (2 mg/kg) was held constant for each patient visit; however, N2O (50%) was administered during one visit and O2 (100%) at the other in a randomly determined manner. Physiologic and behavioral parameters were collected during eight specific procedural events (e.g., administration of local anesthesia). Data were analyzed with a repeated-measures ANOVA, one-way ANOVA, t-test, Kruskal Wallis ANOVA, and descriptive statistics. There was no statistically significant difference in any physiologic or behavioral parameter as a function of inhalation agent. However, significant differences were found for certain physiological parameters (i.e., HR [F = 5.41, P < 0.001], pO2 [F = 6.04, P < 0.001], and CO2 [F = 2.33, P < 0.027]) and all behavioral measures (% crying [F = 2.82, P < 0.008], % quiet [F = 5.38, P < 0.001], % movement [F = 3.88, P < 0.001], and % struggle [F = 2.83, P < 0.007]) of one scale (Ohio State University Behavioral Rating Scale [OSUBRS]) as a function of procedural events. Although no statistically significant differences were attributable to inhalation agent, evidence suggests that N2O resulted in less crying and struggling and more quiet behaviors than O2. Significant correlations existed between sub-categories of the two behavioral rating scales, suggesting some association between the scales. One may conclude from the results of this study that moderate doses of CH and hydroxyzine in combination with nitrous oxide are not associated with any significant potentiation effects on physiologic parameters compared with the same oral agents with oxygen alone. Certain procedural events (e.g., administration of local anesthesia) do result in patient responses that affect specific behaviors and physiology. Although the effects of N2O may not be statistically significant, generally it produces an attenuation in physiological and behavioral responses as measured under the conditions of this study.
本研究的目的是采用双盲交叉设计，比较20名（平均年龄45±5.1个月）用氯水合醛（CH）和羟嗪镇静的儿童，吸入氧化亚氮/氧气（N2O）与单纯吸氧（O2）时心率（HR）、血压（BP）、外周血氧饱和度（pO2）、呼出二氧化碳（CO2）以及行为（使用两种量表）的差异。每次患者就诊时，CH（40mg/kg）和羟嗪（2mg/kg）的给药量保持恒定；然而，在一次就诊时以随机确定的方式给予N2O（50%），在另一次就诊时给予O2（100%）。在八个特定的手术过程事件（如局部麻醉给药）中收集生理和行为参数。数据采用重复测量方差分析、单因素方差分析、t检验、Kruskal Wallis方差分析和描述性统计进行分析。作为吸入剂的函数，任何生理或行为参数均无统计学显著差异。然而，在一个量表（俄亥俄州立大学行为评定量表[OSUBRS]）中，某些生理参数（即HR[F = 5.41，P < 0.001]、pO2[F = 6.04，P < 0.001]和CO2[F = 2.33，P < 0.027]）以及所有行为指标（哭闹百分比[F = 2.82，P < 0.008]、安静百分比[F = 5.38，P < 0.001]、活动百分比[F = 3.88，P < 0.001]和挣扎百分比[F = 2.83，P < 0.007]）作为手术过程事件的函数存在显著差异。虽然没有统计学显著差异可归因于吸入剂，但有证据表明，与O2相比，N2O导致的哭闹和挣扎更少，安静行为更多。两个行为评定量表的子类别之间存在显著相关性，表明量表之间存在某种关联。从本研究结果可以得出结论，与相同口服药物单纯吸氧相比，中等剂量的CH和羟嗪联合氧化亚氮对生理参数无任何显著增强作用。某些手术过程事件（如局部麻醉给药）确实会导致患者出现影响特定行为和生理的反应。虽然N2O的作用可能无统计学显著意义，但一般来说，在本研究条件下测量时，它会使生理和行为反应减弱。
