【摘要】 目的 探讨笑气吸入和咪达唑仑口服溶液在咽反射敏感患儿口腔治疗中的应用效果。方法 63例需进行口腔治疗伴咽反射敏感的患儿,按治疗方式不同分为A组（21例,吸入浓度低于50%的笑气）、B组（21例,口服咪达唑仑口服溶液）、C组（21例,未使用任何药物预防咽反射）。比较三组患儿生理指标[术前、术中的心率（HR）和血氧饱和度（SpO₂）]、Frankl评分、咽反射次数、儿童畏惧量表-牙科分量表（CFSS-DS）评分、疗效, A组与B组麻醉后离院评估系统（PADSS）评分。结果 A组和B组患儿术前、术中的HR和SpO₂均较平稳,组内比较差异无统计学意义（P>0.05）;C组患儿的术中HR（114.48±10.58）次/min明显高于术前的（102.52±10.40）次/min,差异有统计学意义（P<0.05）;C组患儿术前、术中SpO₂比较差异无统计学意义（P>0.05）。A组和B组患儿的Frankl评分（3.48±0.48）、（3.24±0.67）分明显高于C组的（2.10±0.89）分,咽反射次数（2.38±0.86）、（2.71±0.96）次明显少于C组的（6.57±1.16）次,差异均有统计学意义（P<0.05）;A组和B组患儿的Frankl评分、咽反射次数比较差异无统计学意义（P>0.05）。术后1周, A组和B组患儿CFSS-DS评分与术前相比下降,且A组和B组患儿CFSS-DS评分（34.38±8.24）、（35.14±8.87）分低于C组的（42.38±6.98）分,差异有统计学意义（P<0.05）;C组术前、术后1周的CFSS-DS评分比较差异无统计学意义（P>0.05）。术后30、60 min, A组患儿PADSS评分10（9, 10）、10（10, 10）分比B组的9（8, 10）、10（8.5, 10）分高,差异有统计学意义（P<0.05）；术后90 min, A组与B组患儿PADSS评分比较差异无统计学意义（P>0.05）。A组和B组患儿的治疗总有效率85.71%、76.19%显著高于C组的33.33%,差异有统计学意义（P<0.05）;A组和B组患儿的治疗总有效率比较差异无统计学意义（P>0.05）。结论 笑气吸入和咪达唑仑口服溶液在儿童口腔治疗中,可以有效缓解患儿咽反射敏感和焦虑,值得临床推广。更多还原

【Abstract】 Objective To explore the application effect of nitrous oxide inhalation and midazolam oral solution in oral treatment of children with sensitive gag reflex. Methods 63 child patients with sensitive gag reflex who needed oral treatment were divided into Group A（21 cases, nitrous oxide inhalation with a concentration below 50%）, Group B（21 cases, orally administered midazolam oral solution）, and Group C（21 cases, no medication was used to prevent pharyngeal reflex） according to different treatment methods. Comparison was made on physiological indicators [preoperative and intraoperative heart rate（HR） and blood oxygen saturation（SpO₂）, Frankl score, pharyngeal reflex frequency, and Children’s Fear Survey Schedule-Dental Subscale（CFSS-DS） score, and therapeutic effect among the three groups, as well as postanesthetic discharge scoring system（PADSS） scores in Group A and Group B. Results Preoperative and intraoperative HR and SpO₂ remained stable in Group A and Group B, with no statistically significant differences within groups（P>0.05）. The intraoperative HR of children in group C was（114.48±10.58） beats/min, which was significantly higher than that preoperatively [（102.52±10.40） beats/min], and the difference was statistically significant（P<0.05）. Preoperative and intraoperative SpO₂ levels in Group C showed no statistically significant differences（P>0.05）. The Frankl scores of children in Group A and Group B were（3.48±0.48） and（3.24±0.67） points, which were significantly higher than（2.10±0.89） points in Group C; the frequency of pharyngeal reflex were（2.38±0.86） and（2.71±0.96） times, which was significantly less than（6.57±1.16） times in Group C; the difference was statistically significant（P<0.05）. There was no statistically significant difference in the Frankl score and the frequency of pharyngeal reflex between Group A and Group B（P>0.05）. 1 week postoperatively, CFSS-DS scores decreased in Group A and Group B compared to preoperatively. The CFSS-DS scores were（34.38±8.24） and（35.14±8.87） points in Group A and Group B, which were significantly lower than（42.38±6.98） points in Group C, and the difference was statistically significant（P<0.05）. There was no statistically significant difference in the CFSS-DS scores of group C preoperatively and 1 week postoperatively（P>0.05）. At 30 and 60 min postoperatively, Group A patients had significantly higher PADSS scores than Group B [10（9, 10） vs. 9（8, 10） points; 10（10, 10） vs. 10（8.5, 10） points], and the difference was statistically significant（P<0.05）. At 90 min postoperatively, the difference in PADSS scores between Group A and Group B was not statistically significant（P>0.05）. The overall treatment efficacy rates were 85.71% and 76.19% in Group A and Group B, which were significantly higher than 33.33% in Group C, and the difference was statistically significant（P<0.05）. No statistically significant difference was observed between the overall treatment efficacy rates between Group A and Group B（P>0.05）. Conclusion Nitrous oxide inhalation and midazolam oral solution can effectively control the sensitive gag reflex and anxiety of the child patients, and is worthy of clinical promotion.更多还原