短暂吸入七氟烷用于小儿腰椎穿刺术的临床观察

Observation of Short-Term Sevoflurane Anesthesia for Lumbar Puncture in Children

目的观察短暂吸入七氟烷用于小儿腰椎穿刺术的镇静效果。方法选择2013年2月至2014年2月于广州市妇女儿童医疗中心拟行腰椎穿刺术的113例患儿为研究对象,按照术前镇静方式的不同,将其分为采用吸入七氟烷麻醉镇静的S组(n=58)和采用静脉输注地西泮镇静的D组(n=55)。本研究遵循的程序符合广州市妇女儿童医疗中心人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。两组患儿的年龄、性别、病情程度等一般临床资料比较,差异无统计学意义(P>0.05)。常规监测两组患儿生命体征,记录穿刺时间、一次性穿刺成功率及总穿刺成功率,记录麻醉或镇静过程中体动反抗等不良反应。结果 1S组患儿T2时刻心率显著增快,与本组T1时刻心率比较,差异有统计学意义(t=-6.39,P<0.05);D组患儿T3、T4时刻心率显著增快,与本组T1时刻心率比较,差异也有统计学意义(t=8.80,6.82;P<0.05);两组患儿T2、T3、T4时刻心率比较,差异有统计学意义(t=4.909,-13.382,-12.733;P<0.01)。2D组患儿T3时刻的血氧饱和度(SpO2)较本组其他3个观察时刻明显下降,前者分别与后3者比较,差异均有统计学意义(t=-7.70,-7.74,-7.91;P<0.05)。两组患儿T3时刻的SpO2比较,差异也有统计学意义(t=8.141;P<0.01)。3S组58例患儿在局部麻醉及腰椎穿刺术过程中无一例发生体动反应,放弃操作患儿为1例(1.7%);D组出现体动反应为40例(72.7%),放弃操作患儿为8例(14.5%)。4S组的一次性穿刺成功率和总穿刺成功率分别为86.2%和98.3%,而D组分别为65.5%和85.5%,两组比较,差异均有统计学意义(P<0.05)。5S组穿刺时间为(7.6±2.1)min,D组为(16±8.7)min,两组比较,差异也有统计学意义(P<0.05)。6S组患儿吸入七氟烷后的入睡时间为(78.3±21.4)s,苏醒时间为(7.3±2.1)mm。结论短暂吸入七氟烷进行腰椎穿刺术的镇静,可提高一次性穿刺成功率和总穿刺成功率,缩短穿刺时间,减少体动反应所致的潜在神经损伤。

Objective To observe the effect of short-term sevoflurane anesthesia for lumbar puncture in children. Methods From February 2013 to February 2014,113 children who underwent lumbar puncture in Guangzhou Women and Children＇ s Medical Center were included in the study. They were divided into group S （sevoflurane inhaled, n ： 58） and group D（diazepam injection, n = 55） according to different ways of sedation. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangzhou Women and Children＇s Medical Center. Informed consent was obtained from each participants＇ parents. No significant difference was found in general clinical data such as age, sex and degree of illness between two groups（P^0. 05）. The vital signs were observed in both groups. The duration of lumbar puncture, one-time puncture success rate and total success rate of puncture were recorded. The adverse events such as body movement during the operation were also recorded. Results （1） Heart rate at T2 was obviously higher than that of T1 in group S（t= -6.39,P〈0.05）. Heart rates at T3 ,T4 were also higher than T1 in group D（t=8.8,6.82;P〈0.05）. There were significant differences in heart rate at T2 ,T3 ,T4 between two groups（t= 4. 909,-13. 382,-12. 733 ;P〈0.01）. （2）Compared with the other observing time, blood oxygen saturation （Spo2 ） at T3 was decreased obviously in group D（t=- 7.70,-7.74,-7.91; P〈0.05）. There was significant difference in Spo2 at T3 between two groups（t=8. 141 ,P〈0.01）. （3）No one had body movement during the operation in group S, and 1 case quited the operation（1.7%）, forty cases （72.7%） had body movement during the operation in group D,and 8 cases quited the operation（14.5%）. （4）There were significant differences in one-time puncture success rate and total puncture success rate between two groups （P〈0.05）. （5）The duration of lumbar puncture in group S was （7.6±2.1） min, which was obviously shorter than （16.0±8.7） min of group D（P〈0.05）. （6） The anesthesia time was （78.3±21.4） sandrecoverytimewas （7.3±2.1） miningroup S. Conclusions Short-termsevofluraneanesthesiacan improve one-time puncture success rate and shorten the duration of the lumbar puncture. It also can reduce the potential nerve damage.