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的镇痛效果

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。

Efficacy of Diazepam and Phenobarbitone Combining with Surface Anesthesia in Preterm Infants with Retinopathy Undergoing Laser Therapy

Objective To evaluate the safety and efficiency of Diazepam and Phenobarbitone combining with surface anesthesia for laser treatment of threshold retinopathy of prematurity(ROP). Methods A cohort of 66 eyes of 33 neonates with threshold ROP were diagnosed threshold ROP by binocular indirect ophthalmoscope and fundus photography by Ret Cam Ⅱ,and treated by diode laser peripheral retinal ablation.Phenobarbitone(10 mg·kg-1) were injected by vein 30 min before treatment,intravenous injection of diazepam(0.4 mg·kg-1) and 5 g·L-1 Proparacaine hydrochloride Eye Drops were given 5 min before treatment.Crying,requires O2 saturation,increased vital signs,expression,sleeplessness(CRIES) pain measurement scores were recorded before the treatment,and every 15 min during and 15,30 min after the treatment,and the maximum score was used to assess the patients′ tolerance to the treatment.Stress was assessed by the perioperatively microscale blood glucose. Results The mean treatment duration was(34.4±10.1) min(17-53 min).The mean laser counter was(1 228.7±542.7) points(290-2 350 points).The average value of maximum scores for the CRIES was(1.90±1.18) scores,which was significantly less than 4 scores.There were 29 neonates(87.9%) whose scores was less than 4 and it was not necessary to add drug dosage.Four neonates whose maximum scores for the CRIES exceeded 4 scores were given added dosage.Postoperatively microscale blood glucose (6.3±1.2) mmol·L-1] was significantly higher than the preoperative (5.4±1.7) mmol·L-1](t=3.987,P<0.05);Perioperative complications:All the babies had conjunctival haemorrhage and cornea chemosis,but the planned dose of laser was delivered.A short apnea was seen in 6 cases,which recovered rapidly with the treatment of touching intervention,or oxygen therapy,or intravenous dripping of amino-phylline,or breathing apparatus assisted ventilation. Conclusions Diazepam and Phenobarbitone combining with surface anesthesia appears to be a safe and effective alternative anesthesia for laser treatment of threshold ROP.The operation can be done in NICU.