丙泊酚麻醉下肉毒毒素注射治疗小儿痉挛性脑瘫的临床观察

Clinical observation of botulinum toxin injection with propofol anesthesia in the treatment of infantile spastic cerebral palsy

目的观察丙泊酚麻醉下肉毒毒素注射治疗小儿痉挛性脑瘫的镇痛效果。方法选取2014年1月-2015年12月聊城市人民医院康复科门诊收治的脑瘫患儿,随机分为观察组(丙泊酚麻醉下肉毒毒素注射组)和对照组(单独肉毒毒素注射组),注射后常规进行康复训练;注射过程中对心率、呼吸、收缩压、经皮测血氧饱和度进行评判;在治疗后1、3、6个月采用改良Ashworth修正量表(MAS)、粗大运动功能量表(GMFM)对患儿依从性进行评判。结果临床符合条件患儿共76例,观察组和对照组各38例,与对照组比较,观察组的心率、收缩压变化差异有统计学意义(P<0.05),对照组的心率明显增快;而两组间比较,经皮血氧饱和度比较差异无统计学意义(P>0.05);观察组未出现呼吸抑制。MAS和GMFM评分在观察组与对照组治疗后各个时间段与治疗前比较,差异均有统计学意义(P<0.05),治疗后3月与6月比较差异无统计学意义;观察组与对照组在同一个时间段MAS和GMFM评分比较差异无统计学意义,但观察组MAS值低于对照组,而GMFM值较对照组偏高。观察组再次注射率达98%,而对照组再次注射率为70%,两者比较差异有统计学意义。结论丙泊酚镇痛效果确切且使用安全、操作方便,患儿术中配合良好,依从性高,脑瘫患儿接受肉毒毒素注射时镇痛管理是非常重要的。

Objective To observe the analgesic effect of botulinum toxin injection under propofol anesthesia in the treatment of children with spastic cerebral palsy.Methods Children with cerebral palsy admitted in hospital from January 2014 to December 2015 were randomly divided into observation group (propofol anesthesia botulinum toxin injection group) and control group (botulinum toxin injection alone),the routine rehabilitation training after injection;heart rate,respiration,systolic blood pressure,percutaneous oxygen saturation during the injection to judge.Patient compliance were evaluated at 1,3 and 6 months after treatment by the Modified Ashworth Scale (MAS),Gross Motor Function Scale (GMFM).Results A total of 76 patients were eligible.The difference of heart rate and systolic blood pressure in the control group were significantly (P<0.05).The heart rate of the control group was significantly faster than that of the observation group.There was no significant difference about the percutaneous oxygen saturation between the two groups;the treatment group did not appear respiratory depression.The scores of MAS and GMFM between the observation group and the control group were significantly different (P<0.05) at each time point after treatment,and there was no significant difference between the two groups after the treatment in March and June;The MAS and GMFM scores in the same time between the observation group and the control group were not statistically significantly different.The score of MAS in the observation group is lower than that in the control group,and the score of GMFM is higher than that of the control group.The rate of re-injection was 98% in the observation group and 70% in the control group.There was significant different between the two groups.Conclusions Propofol is an effective and safe analgesic,safe and easy to use.It is very important to manage analgesic in children with cerebral palsy by receiving botulinum toxin injection.