“布他卡因”的替代药物：儿童缝合术前低剂量肌肉注射氯胺酮与鼻内咪达唑仑的比较
An alternative to "brutacaine": a comparison of low dose intramuscular ketamine with intranasal midazolam in children before suturing.
作者信息
McGlone R G, Ranasinghe S, Durham S
机构信息
Accident and Emergency Department, Royal Lancaster Infirmary.
出版信息
J Accid Emerg Med. 1998 Jul;15(4):231-6. doi: 10.1136/emj.15.4.231.
OBJECTIVE
To compare the use of low dose intramuscular ketamine with high dose intranasal midazolam in children before suturing.
METHODS
Altogether 102 children with simple wounds between 1 and 7 years old were allocated to the two study groups.
RESULTS
Two children were excluded from the study because of deviation from the agreed protocol. The 50 children in the ketamine group were less likely to cry or need to be restrained during the procedure than those in the midazolam group (p < 0.01). The median oxygen saturation was 97% in both groups. There was no difference in the recovery behaviour and the range of time at which children were ready for discharge, although the median time for the latter was shorter in the midazolam group (75 v 82 minutes). Vomiting occurred in nine of the ketamine and four of the midazolam group. After discharge both groups had an unsteady gait (73% v 71%) which usually resolved within two hours.
CONCLUSION
Intranasal midazolam (0.5 mg/kg) effectively sedated the children in that none could remember the suturing. However a significant number still had to be restrained (86% v 14%). Intramuscular ketamine (2.5 mg/kg) produced dissociative anaesthesia in the majority of cases and was the preferred drug of nurse, doctor, and parent.
目的
比较在儿童缝合前使用低剂量肌内注射氯胺酮与高剂量鼻内咪达唑仑的效果。
方法
将102名1至7岁的单纯伤口儿童分配到两个研究组。
结果
两名儿童因偏离商定方案而被排除在研究之外。氯胺酮组的50名儿童在手术过程中哭泣或需要约束的可能性低于咪达唑仑组（p<0.01）。两组的中位血氧饱和度均为97%。恢复行为以及儿童准备出院的时间范围没有差异，尽管咪达唑仑组后者的中位时间较短（75对82分钟）。氯胺酮组有9名儿童呕吐，咪达唑仑组有4名儿童呕吐。出院后两组均步态不稳（73%对71%），通常在两小时内恢复。
结论
鼻内咪达唑仑（0.5mg/kg）有效地使儿童镇静，以至于没有人能记住缝合过程。然而，仍有相当数量的儿童需要约束（86%对14%）。肌内注射氯胺酮（2.5mg/kg）在大多数情况下产生分离麻醉，是护士、医生和家长首选的药物。
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