儿童白血病无痛性化疗鞘注的临床研究

Research on Analgesia Intrathecal Injection in Acute Leukemia Among Children

目的探讨儿童急性白血病(急性淋巴细胞白血病、急性髓细胞白血病)化疗鞘注过程中应用芬太尼联合异丙酚进行镇静、镇痛,减少鞘注困难甚至操作失败,为今后急性白血病患儿化疗鞘注提供一种无痛的操作方法。方法选择需进行化疗鞘注患儿用芬太尼联合异丙酚镇痛、镇静为实验组,以只用利多卡因局麻后行化疗鞘注为对照组,观察术中配合情况、给药时的反应、异丙酚用量、术中反应。结果实验组给药后能达到较好的镇静、镇痛状态,剂量控制好后无明显呼吸抑制的发生,少数有鼾声呼吸的发生,但术后均能迅速恢复;对照组术前、术中配合率低、躁动、哭叫明显,操作难度大。结论实验组患儿在鞘注中疼痛明显减少、依从性、一次腰穿成功率高,与对照组相比P<0.01,用芬太尼联合异丙酚对小儿镇静、镇痛进行化疗鞘注安全、有效。

Objective To explore the sedation and analgesia effects of fentanyl combined propofol in chemotherapy intrathecal injection on acute leukaemia （acute lymphocytic leukemia, ALL; or acute myelocytic leukemia, AML） among children, so as to relieve pain and difficulty in intrathecal injection, aimed to supply a painless procedure for children with acute leukaemia. Methods Fifty-six person times received fentanyl combined propofol in chemotherapy intrathecal injection among the hospitalized children with leukaemia for the experimental group. At the same period of hospitalization only local anesthesia with lidocaine underwent intrathecal chemotherapy for the control group. The main observation of subjects with intraoperative conditions （agitation, crying, sweating）, the reaction during administration. Results In the treatment group, the patients were quiet during the whole procedure of lumbar puncture and intrathecal injection, showing good results of sedation and analgesia. No obvious respiratory depression occurred with proper dosages. Only a few patients showed stertorous respiration which stopped soon after the procedures. In the control group, the patients were agitated, crying and not cooperative before and during the procedures, which made the procedures very difficult. Conclusion During intrathecal injection, pain reduces obviously with high reliance and success rate of single lumbar puncture, It is safe and effective to apply fentanyl combined propofol for sedation and analgesia.