两种局麻方案控制儿童肾穿刺活检疼痛效果及安全性的随机对照研究

Randomized controlled study on the efficacy and safety of two local anesthesia regimens in the control of renal biopsy pain in children

目的探讨利多卡因胶浆表面麻醉联合利多卡因注射液局部浸润麻醉控制儿童经皮肾穿刺活检疼痛的效果及安全性。方法采用前瞻性随机对照试验设计,选择2019年1月至2022年6月在中国人民解放军联勤保障部队第924医院住院需行肾穿刺活检的50例患儿,采用随机数字表分为治疗组和对照组各25例。治疗组予利多卡因胶浆表面麻醉,起效后予利多卡因注射液局部浸润麻醉行彩超引导下经皮肾穿刺活检。对照组使用医用超声耦合剂代替利多卡因胶浆,其余操作方法同治疗组。比较两组麻醉进针时、手术进针时、手术中、手术后1小时的疼痛情况,术后并发症,手术后镇痛药使用量及使用时间,肾穿刺活检标本肾小球数及肾穿刺活检穿刺成功率。结果两组间麻醉进针时、手术进针时疼痛评分比较差异有统计学意义(P<0.01);手术中、手术后1小时疼痛评分比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。两组手术后均未使用镇痛药物。两组肾穿刺活检标本光镜下肾小球数及总肾小球数比较差异无统计学意义(P>0.05)。对照组穿刺成功率为84.0%,治疗组穿刺成功率为96.0%,治疗组成功率更高,但差异无统计学意义(P>0.05)。结论儿童经皮肾穿刺活检常规局麻前加用利多卡因胶浆表面麻醉可取得满意镇痛效果,尤其是减轻麻醉进针时疼痛,且不增加手术及麻醉并发症。此麻醉方案可让肾病患儿易于接受肾穿刺,明确病理诊断及时调整治疗,减少终末期肾病的发生,值得临床推广。

Objective To explore the effect and safety of surface anesthesia with lidocaine hydrochloride mucilage combined with local infiltration anesthesia with lidocaine injection in controlling pain during percutaneous renal biopsy in children.Methods A prospective randomized controlled trial design was used.50 children who were hospitalized in the 924th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army for renal biopsy from January 2019 to June 2022 were selected.The children were divided into treatment group and control group by random number table,with 50 cases in each group.The treatment group were given surface anesthesia with lidocaine hydrochloride mucilage,and color ultrasound guided percutaneous renal puncture biopsy was performed under local infiltration anesthesia with lidocaine injection after taking effect.In the control group,medical ultrasonic coupling agent was used to replace lidocaine hydrochloride mucilage,the other operation methods were the same as the treatment group.And then,the pain at the time of anesthesia injection,at the time of renal puncture operation,during renal puncture operation and 1 hour after operation were compared between the two groups.In addition,postoperative complications,postoperative analgesic dosage and duration,the number of glomeruli in renal biopsy specimens and the success rate of renal biopsy puncture were compared between the two groups.Results There was statistically significantly difference in pain scores during anesthesia and renal puncture between the two groups(P<0.01).There was no statistically significant difference in pain scores during operation and 1 hour after operation(P>0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).No analgesic drugs were used after renal perforation in both groups.There was no statistically significant difference in the number of glomeruli and total glomeruli between the two groups(P>0.05).Puncture success rate of the control group was 84.0%,and that of the treatment group was 96.0%,the treatment group had higher puncture success rate,but the difference was not statistically significant(P>0.05).Conclusion Percutaneous renal biopsy in children with surface anesthesia with lidocaine hydrochloride mucilage can achieve satisfactory analgesic effect,especially in reducing pain during anesthesia needle insertion,and does not increase the complications of surgery and anesthesia.This anesthesia scheme can make it easy for children with kidney disease to undergo renal puncture,confirm pathological diagnosis and adjust treatment in time,reduce the occurrence of end-stage nephropathy,and thus is worthy of clinical promotion.