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目的探讨地西泮、苯巴比妥联合表面麻醉对激光治疗早产儿视网膜病(ROP)的有效性和安全性。方法选择经双目间接检眼镜及Ret Cam Ⅱ眼底照相确诊的33例(66只眼)阈值期ROP患儿进行激光光凝术,术前30 min静脉注射苯巴比妥10mg·kg-1、术前5 min静脉注射地西泮0.4 mg.kg-1及结膜囊滴入5 g·L-1盐酸丙美卡因滴眼液。于术前、术中每隔15 min及术后15 min、30 min,分别对患儿进行CRIES疼痛评估,取最高分评估患儿在常规镇静联合表面麻醉下对激光手术的耐受程度。术前、术后检测其微量血糖评估患儿应激状态。结果激光手术持续时间为(34.4±10.1)min(17～53 min),激光点数为(1 228.7±542.7)点(290～2 350点);CRIES疼痛评分术中最高得分为(1.90±1.18)分,明显小于疼痛阈值(4分),其中29例全程得分<4分,占87.9%(29/33例),4例术中最高得分≥4分,经追加给药后手术均顺利完成;术后血糖[(6.3±1.2)mmol·L-1]显著高于术前[(5.4±1.7)mmol·L-1](t=3.987,P<0.05)。术中、术后并发症:术中均出现结膜下出血和角膜水肿,但不影响手术;仅6例在术中或术后出现短时呼吸暂停,经抚触、给氧或静脉滴注氨茶碱、或短期辅助通气等处理后较快缓解。结论地西泮、苯巴比妥联合表面麻醉进行激光治疗ROP,镇痛效果可靠、简便、安全,可在NICU内开展。
Objective To investigate the efficacy and safety of diazepam and phenobarbital in combination with topical anesthesia for laser treatment of retinopathy of prematurity (ROP). Methods Thirty-three (66 eyes) ROP children diagnosed by fundus examination with binocular indirect ophthalmoscope and Ret Cam Ⅱ fundus were enrolled in this study. Laser photocoagulation was performed at 30 min before the operation. Phenobarbital 10 mg · kg- 5 min before surgery, intravenous diazepam 0.4 mg.kg-1 and conjunctival sac dropping 5 g · L-1 propamocin hydrochloride eye drops. CRIES pain was assessed in children before and 15 min after operation and 15 min and 30 min after operation, respectively. The highest score was used to evaluate the tolerance of laser surgery under routine sedation combined with topical anesthesia. Preoperative and postoperative detection of trace glucose in children with stress status. Results The duration of laser surgery was (34.4 ± 10.1) min (17-53 min) and the number of laser points was (1 228.7 ± 542.7) points (290-2 350). The highest intraoperative CRI pain score was (1.90 ± 1.18) (4 points) in 29 cases, accounting for 87.9% (29/33 cases) in all 29 cases, and the highest score in 4 cases was ≥4 points. The surgery was completed successfully after additional administration. Postoperative blood glucose [(6.3 ± 1.2) mmol·L-1] was significantly higher than [5.4 ± 1.7 mmol·L-1] (t = 3.987, P <0.05). Intraoperative and postoperative complications: subconjunctival hemorrhage and corneal edema occurred during the operation, but surgery was not affected. Only 6 cases had short-term apnea during or after operation. After touching, oxygen or intravenous infusion of ammonia Theophylline, or short-term assisted ventilation and other treatment faster relief. Conclusion Diazepam and phenobarbital combined with surface anesthesia laser treatment of ROP, analgesic effect is reliable, simple and safe, can be carried out within the NICU.