论文部分内容阅读
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 in children with spastic cerebral palsy under propofol anesthesia. Methods From January 2014 to December 2015, children with cerebral palsy who were admitted to rehabilitation department of Liaocheng People’s Hospital were randomly divided into observation group (botulinum toxin injection group under propofol anesthesia) and control group (botulinum toxin injection alone Group). After injection, routine rehabilitation training was performed. Heart rate, respiration, systolic pressure and percutaneous oxygen saturation were evaluated during injection. Modified Ashworth’s Modified Scale (MAS) , Gross motor function scale (GMFM) to evaluate children’s compliance. Results There were 76 cases of children eligible for clinical treatment, 38 cases in observation group and control group respectively. Compared with control group, there were significant differences in heart rate and systolic blood pressure in observation group (P <0.05), heart rate of control group increased significantly ; While between the two groups, the difference of percutaneous oxygen saturation was not statistically significant (P> 0.05); the observation group did not appear respiratory depression. The scores of MAS and GMFM in the observation group and the control group at each time period after treatment were significantly different from those before treatment (P <0.05), but there was no significant difference between March and June after treatment There was no significant difference in MAS and GMFM score between the two groups at the same time point, but the MAS value in the observation group was lower than that in the control group, while the GMFM value was higher than that in the control group. Observation group re-injection rate of 98%, while the control group re-injection rate was 70%, the difference between the two was statistically significant. Conclusion The analgesic effect of propofol is safe, safe and easy to operate. Children with cerebral palsy receiving good dose of botulinum toxin are very important for the management of children with cerebral palsy.