| 摘要: |
| 目的：优选儿童白血病侵袭性操作镇静镇痛方案。方法：选取2011年11月至2016年11月在我院进行侵袭性操作的白血病患儿，根据选用的镇静镇痛方案分为A（咪达唑仑+局麻）、B（咪达唑仑+氯胺酮+局麻）、C（咪达唑仑+芬太尼+局麻）、D（芬太尼+丙泊酚+局麻）4组各210例。镇静效果评价参照Ramesay评分法：1分-不安静，烦燥，哭闹；2分-安静合作；3分-嗜睡能听从指令；4分-睡眠状态，可唤醒；5分-呼吸反应迟钝；6分-深睡状态，呼唤不醒。术后疼痛评估采用面部表情评估法，包括脸谱疼痛评分法（适用于婴幼儿）和改良面部表情评分法（适用于学龄儿童和青少年）。采用χ2检验比较4组方案的镇静镇痛效果及不良反应。结果：B、D组镇静效果优于A、C组（P<0.01），D组优于B组（P<0.05），A、C组比较差异无统计学意义（P>0.05）。B、D组镇痛效果优于A、C组（P<0.01），B、D组比较差异无统计学意义（P>0.05）。B、C组幻觉发生率高于A、D组（P<0.01），B组恢复清醒时间比其他各组长（P<0.01）。结论：在充分做好辅助呼吸准备和严密监测的情况下，丙泊酚联用小剂量芬太尼（D组方案）应用于儿童白血病侵袭性操作，是一种较好的镇静镇痛方法，疗效较好、清醒时间短、安全易行。 |
| 关键词: 侵袭性操作 儿童 镇静 镇痛 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2021.02.007 |
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| 基金项目: |
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| Comparison of Invasive Operative Sedation and Analgesia Regimens in Children with Leukemia |
| Wang Jiayi, Huang Rulin, He Yingyi, Xie Jianling, Zhang Hui, Xu Xiuxian, Liang Zhimin, Huang Haiying, Huang Yongxian |
| (Guangzhou Women and Children’s Medical Center, Guangdong Guangzhou 510623, China) |
| Abstract: |
| Objective: To optimize invasive operative sedation and analgesia regimens in children with leukemia. Methods: From Nov. 2011 to Nov. 2016, children with leukemia undergoing invasive operative sedation in our hospital were extracted to be divided into A (midazolam + local anesthesia) and B (midazolam + ketamine+ local anesthesia), C (midazolam + fentanyl + local anesthesia) and D (fentanyl + propofol + local anesthesia) according to different invasive operative sedation and analgesia regimens, with 210 cases in each group. Sedative effect was evaluated according to Ramesay scale: 1-anxious, agitated and restless; 2-cooperative, oriented and tranquil; 3-responsive to commands only; 4-brisk response to light glabellar tap or loud auditory stimulus; 5-sluggish response to light glabellar tap or loud auditory stimulus; 6-no response to light glabellar tap or loud auditory stimulus. Postoperative pain was assessed by using facial expression assessment, including facial pain rating (for infants and young children) and modified facial expression rating (for school-age children and adolescents). χ2 test was used to compare the operative sedation and analgesia effect and adverse drug reactions of four groups. Results: The sedative effect of group B and D was better than that of group A and C (P<0.01), and that of group D was better than that of group B (P<0.05), there was no significant difference between group A and C (P>0.05). The analgesic effect of group B and D was better than that of group A and C (P<0.01), but there was no significant difference between group B and D (P>0.05). The incidence of hallucination in group B and C was higher than that in group A and D (P<0.01), and the recovery time of group B was longer than that of other groups (P<0.01). Conclusion: In the case of adequate preparation for assisted breathing and close monitoring, propofol combined with low-dose fentanyl is a good invasive operative sedation and analgesia regimen in children with leukemia, with more significant efficacy, shorter wakening time and higher safety. |
| Key words: invasive procedure children sedation analgesia |
