口服咪达唑仑治疗牙科恐惧症儿童的临床疗效观察

[摘要] 目的 对牙科恐惧症儿童实施口服咪达唑仑镇静下的口腔治疗，评估治疗的安全性、有效性及其影响因素。方法 选择在口腔科就诊的Frankl量表评分为1的有不良牙科治疗经历的30例患儿为研究对象，共进行了46人次的口服咪达唑仑（0.5～1.0 mg·kg-1）镇静下治疗。治疗时，记录患儿的心率、血氧饱和度、治疗内容及持续时间等。

采用Houpt量表评估患儿治疗完成情况，治疗结束24 h后电话回访不良反应。结果 46人次治疗中，患儿的生命体征平稳、安全，37人次（80.4％）完成了既定治疗，9人次（19.6％）镇静效果不理想，仅完成部分治疗。烦躁不安是术后最常见的不良反应。3岁以上儿童的治疗成功率高于3岁及以下儿童，性别、剂量和治疗内容与治疗成功率无关。结论 口服咪达唑仑治疗牙科恐惧症儿童是一种安全有效的方法，3岁以上儿童的治疗效果较好。

[关键词] 牙科恐惧； 咪达唑仑； 镇静； 儿童； 不良牙科经历

[中图分类号] R 788 [文献标志码] A [doi] 10.3969/j.issn.1000-1182.2012.03.012

Evaluation of oral midazolam sedation for reducing dental fear in children with dental fear Ma Lin, Jing Quan, Wan Kuo. （Dept. of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College, Chi-nese Academy of Medical Sciences, Beijing 100730, China）

[Abstract] Objective To assess the safety, effectiveness and influential factors of oral midazolam sedation for re-ducing dental fear in children with dental fear. Methods 30 children with traumatic dental experience, who were classified as 1 by Frankl behavior rating scale, were included in the study. Each child was treated under sedation with oral midazolam（0.5-1.0 mg·kg-1）, and totally 46 person-time sedation treatments were conducted. At each visit,

heart rate, arterial oxygen saturation, persistent period and treatment types were recorded. Treatment performed was rated by Houpt scale. Telephone following up was performed to record the side effects 24 h after treatment. Results In all of the 46 person-time treatments, the heart rate, arterial oxygen saturation levels were within acceptable clini-cal limits. 37 person-time planned treatments（80.4％） were completed satisfactorily. Oral sedation was ineffective in

9 person-time treatments（19.6％）, and only a part of planned treatments were completed. Dysphoria after treatment is the main side effect. Children over 3 years old had a high success rate than those under 3 years old. And the suc-cess rate of treatment had no relation with sex, dose and treatment types. Conclusion Oral midazolam could be a safe and acceptable approach of sedation for pediatric dental patients with dental fear, especially to the children over 3 years old.

[Key words]　 dental fear； midazolam； sedation； children； traumatic dental experience

儿童牙科恐惧症患病率高达80%以上，严重影响牙科治疗的顺利进行[1]。对于不合作儿童采用恐吓、欺骗或清醒状态下束缚身体等方法以及涡轮噪音、牙髓治疗、局部麻醉注射、拔牙等侵袭性的牙科治疗内容都可引发或加重牙科恐惧，使得常规治疗无法进行并遗留负面心理影响[1]。有创的医疗操作是儿童

发生牙科恐惧的重要因素，而对曾有不良牙科治疗经历的患儿进行牙科治疗更是困难，若采用全身麻醉配合牙科治疗，则不但需要麻醉师参与，而且全身麻醉下牙科治疗费用较高，家长一般不能接受[1-2]。