瑞芬太尼与芬太尼在小儿腺样体扁桃体切除术的麻醉观察

目的探讨瑞芬太尼和芬太尼在小儿腺样体扁桃体切除术中的麻醉管理。方法将74例小儿腺样体扁桃体患儿随机分为两组。A组为瑞芬太尼组,B组为芬太尼组。每组37例。麻醉诱导采用静脉注射咪唑安定、丙泊酚、维库溴胺、地塞米松、瑞芬太尼或芬太尼。麻醉维持两组均采用持续静脉泵注丙泊酚,A组持续静脉泵注瑞芬太尼。结果A组血流动力学比B组血流动力平稳。A组比B组苏醒快,拔管时间短。结论瑞芬太尼与丙泊酚静脉麻醉起效快,作用时间短,可控性强,镇痛作用强,恢复迅速,无蓄积作用,是小儿腺样体扁桃体切除术的一种较好麻醉。     

骶管阻滞复合瑞芬太尼静脉输注在小儿麻醉中的应用

目的 探讨骶管阻滞复合瑞芬太尼静脉输注用于小儿麻醉的临床效果和安全性.方法 60例择期行泌尿外科手术的小儿随机分成2组,骶管阻滞复合瑞芬太尼组(A组)和氯胺酮组(B组),两组各30例.A组应用骶管阻滞复合瑞芬太尼静脉输注麻醉,B组应用氯胺酮静脉输注全身麻醉.于麻醉诱导前、麻醉后5 min、切皮时、术中15 min、术毕记录其平均动脉压、心率、呼吸频率、血氧饱和度,并比较两组苏醒时间及术后早期恢复情况.结果 A组术中呼吸循环状态较B组稳定.A组麻醉苏醒时间为(11.25±4.45)min,B组为(52.80±8.64)min,A组明显短于B组(P＜0.01).B组术后早期恢复情况较A组差.结论 骶管阻滞复合瑞芬太尼静脉输注用于小儿泌尿外科手术,可保证呼吸、循环稳定,是一种较为理想的麻醉方法.     

等效小剂量瑞芬太尼和芬太尼对经口气管插管小儿血流动力学反应的比较

目的比较等效小剂量瑞芬太尼和芬太尼对经口气管插管小儿血流动力学反应的影响。方法选择择期行全身麻醉下整形外科手术的患儿100例,美国麻醉医师协会(ASA)Ⅰ级或Ⅱ级,随机平均分为2组:瑞芬太尼组(R组)和芬太尼组(F组),在丙泊酚麻醉诱导中采用盲法应用瑞芬太尼2μg/kg或芬太尼2μg/kg。采用直接喉镜经口气管插管。监测麻醉诱导前(基础值)、气管插管前即刻、气管插管即刻和气管插管1、2、3、4、5min时的血压(BP)和心率(HR),计算各观察时间点BP和HR相对于基础值的变化率,并计算二重指数(RPP)。结果2组BP和HR的基础值及气管插管时间均无显著性差异。与基础值比较,虽然气管插管导致F组的BP、HR、RPP及其观察期最大值显著增高,但R组气管插管时BP、HR、RPP及其观察期最大值均较基础值显著降低。观察期时间点的BP、HR、RPP及其最大值二组比较均有显著性差异,观察期时间点的收缩压(SBP)和HR变化率及观察期其最大变化率2组比较亦有显著性差异。观察期SBP和HR增加>基础值30%的发生率在F组显著高于R组;但观察期SBP和HR降低>基础值30%的发生率在R组显著高于F组。结论在小儿应用异丙酚静脉麻醉诱导时,联合应用等效小剂量瑞芬太尼较芬太尼更能有效抑制经口气管插管的血流动力学反应。芬太尼2μg/kg不足以完全抑制小儿经口气管插管的血流动力学反应。虽然瑞芬太尼2μg/kg能够完全消除小儿经口气管插管的血流动力学反应,但可导致更多不良的心血管功能抑制。     

瑞芬太尼复合丙泊酚麻醉在小儿气管异物取出术中的应用

目的研究瑞芬太尼在小儿气管异物取出术麻醉中的临床效果及安全性。方法选择美国麻醉学会制定的I～II级标准、年龄2～4岁、行气管异物取出术小儿40例,随机分为观察组和对照组,每组20例。观察组静脉注射丙泊酚3mg/kg诱导麻醉,术中维持丙泊酚1.5mg/(kg.h)微泵注入及瑞芬太尼0.05μg/(kg.min)持续泵注。对照组静脉注射γ-羟丁酸钠90mg/kg诱导麻醉,术中麻醉深度不足时分次静注氯胺酮1.5mg/kg至麻醉满意,并根据手术需要分次追加氯胺酮1mg/kg。记录诱导前(T0),插支气管镜后(T1),拔支气管镜时(T2),清醒时(T3)各时间收缩压、舒张压、心率及动脉血氧饱和度。观察两组苏醒时间,对比两组患儿拔管后上呼吸道梗阻或屏气、苏醒期躁动、术后恶心呕吐的发生率。结果两组T1与T2时血流动力学变化比较,舒张压差异无显著性(P>0.05),其他血流动力学指标变化差异有显著性(P<0.05);观察组患儿气管异物取出术中血流动力学相对平稳,而对照组患儿血流动力学变化较大。瑞芬太尼起效迅速,恶心呕吐、苏醒期躁动、支气管痉挛和术后舌后坠的发生较对照组少,苏醒时间短,而且苏醒效果佳,与对照组相比差异有显著性(P<0.05)。结论瑞芬太尼、丙泊酚复合静脉麻醉可安全有效地用于小儿气管异物取出术,并具有血流动力学稳定、手术麻醉患儿苏醒时间短和苏醒质量高的优点。     

瑞芬太尼与芬太尼在新生儿麻醉中应用的比较

目的 观察瑞芬太尼与芬太尼应用于新生儿麻醉中的差异,评价瑞芬太尼应用于新生儿麻醉的有效性和安全性。方法 新生儿手术40例,行静吸复合气管插管全身麻醉。随机分为两组,瑞芬太尼(R)组及芬太尼(F)组,每组20例。观察麻醉诱导、气管插管时及术中最高的血压、心率;记录术毕停药后患儿自主呼吸恢复满意时间、睁眼时间、拔管时间;观察术中及术后有无麻醉并发症出现。结果 ①两组患儿在麻醉诱导及气管插管时血压心率无显著差异,术中血压心率平稳。②R组患儿停药后自主呼吸恢复满意时间、睁眼时间、拔管时间均明显短于F组。③R组及F组在麻醉诱导期分别有1例及5例出现肌肉僵直。结论 与芬太尼静吸复合麻醉相比,瑞芬太尼应用于新生儿麻醉在麻醉诱导及气管插管反应上无明显差别,但苏醒质量更优,并发症少。     

小剂量芬太尼、瑞芬太尼和舒芬太尼预防儿童经口气管插管心血管反应的比较

目的比较小剂量芬太尼、瑞芬太尼和舒芬太尼对患儿直接喉镜经口气管插管心血管反应的影响。方法选择120例施择期整形外科手术的患儿。随机平均分成对照组、芬太尼组、瑞芬太尼和舒芬太尼组,气管插管前采用盲法分别应用9g/L盐水0.2mL/kg、芬太尼2μg/kg、瑞芬太尼组1μg/kg和舒芬太尼0.2μg/kg。静脉麻醉诱导后采用直接喉镜实施经口气管插管。监测麻醉诱导前、后,气管插管时和气管插管后5min内血压(BP)和心率(HR)及观察期收缩压(SBP)和HR的变化率,并记录观察期SBP和HR达最大值时间及其气管插管后恢复至麻醉诱导后值时间。结果BP和HR基础值及气管插管时间在4组间均无显著性差异。气管插管致BP和HR较基础值显著升高,且是以对照组最为明显,芬太尼组次之,瑞芬太尼和舒芬太尼组最轻。对照组气管插管时BP和HR及其观察期最大值均显著高于芬太尼组、瑞芬太尼和舒芬太尼组;瑞芬太尼组和舒芬太尼组气管插管时的血压和HR及其观察期最大值均显著低于芬太尼组(Pa<0.05)。瑞芬太尼组观察期出现SBP和HR最大值时间显著长于对照组、芬太尼组和舒芬太尼组(Pa<0.05);舒芬太尼和瑞芬太尼组气管插管后SBP和HR恢复至麻醉诱导后值时间显著短于对照和芬太尼组(P<0.05)。瑞芬太尼和舒芬太尼组观察期SBP和HR增加大于基础值30%发生率较芬太尼组显著降低。结论与小剂量芬太尼比较,小剂量舒芬太尼和瑞芬太尼能更有效预防患儿经口气管插管的心血管反应。     

瑞芬太尼复合氯胺酮在小儿全身麻醉中的临床应用

目的总结瑞芬太尼复合氯胺酮在小儿全身麻醉中的应用效果。方法将90例ASAⅠ～Ⅱ级患儿随机分为A、B两组,每组各45例。两组均先按0.02mg/kg的剂量静脉注射咪唑安定,并单次静脉推注氯胺酮2mg/kg,之后,A组用氯胺酮95±7.8μg/kg/min静脉注射泵维持,B组用氯胺酮58±3.8μg/kg/min以及瑞芬太尼0.06±0.02μg/kg/min静脉注射泵维持。术中监测患儿血压、心率及SPO2,观察并记录术后苏醒时间。结果A、B两组患儿血压和SPO2均较平稳,B组患儿心率较术前明显减慢(p<0.05),A组患儿心率较术前明显增快(p<0.05);B组患儿术后麻醉苏醒明显快于A组(p<0.05),且术中氯胺酮用量明显少于A组(p<0.05)。结论瑞芬太尼复合氯胺酮用于小儿全身麻醉既能满足手术需要,又减少了各自用药量,缩短了麻醉苏醒时间,减少了并发症,是一种更安全的麻醉用药方式。     

头皮神经阻滞联合瑞芬太尼靶控输注在小儿开颅手术麻醉中的应用

目的探讨头皮神经阻滞技术联合瑞芬太尼靶控输注在小儿神经外科麻醉中的应用。方法选择30例择期行颅内占位手术的患儿,按随机数字表法分为罗哌卡因神经阻滞组(B组)和对照组(C组),每组15例。常规麻醉诱导行气管插管后,B组于诱导后以0.25%罗哌卡因阻滞耳颞神经、眶上神经、滑车上神经和枕大神经、枕小神经,C组不进行神经阻滞。用丙泊酚和瑞芬太尼靶控输注维持麻醉。记录不同时间点的心率、平均动脉压、脑电双频指数(BIS),以及丙泊酚与瑞芬太尼使用总量、拔管时间,术后4、8、24、48 h疼痛视觉模拟评分(VAS),术后麻醉并发症。结果两组患者术中血流动力学均稳定,B组瑞芬太尼总量[(3.52±1.75)μg/(kg·h)]与C组[(6.54±1.23)μg/(kg·h)比较,差异有统计学意义(P0.01)。两组拔管时间[C组(10.01±8.47)min vs B组(8.35±7.17)min]、丙泊酚使用总量[C组(3.28±1.05)mg/(kg·h)vs B组(3.61±1.29)mg/(kg·h)]及术后并发症的发生率比较,差异均无统计学意义(P0.05)。两组术后4 h和8 h VAS评分比较,差异均有统计学意义(P0.01)。结论头皮神经阻滞技术联合瑞芬太尼靶控输注可减少小儿颅脑手术中瑞芬太尼用量,术后镇痛效果良好。     

瑞芬太尼和芬太尼用于小儿腺样体扁桃体手术的临床研究

目的比较瑞芬太尼和芬太尼用于小儿腺样体刮除、扁桃体摘除术的麻醉效果、苏醒时间、苏醒质量。方法选择80例行小儿腺样体刮除、扁桃体摘除术的小儿,随机分为瑞芬太尼组（R组,n=40）和芬太尼组（F组,n=40）,麻醉诱导给咪唑安定0．05mg／kg,万可松0．1mg／kg,R组用瑞芬太尼1μg／kg,F组用芬太尼3μg／kg。气管插管后控制呼吸。术中维持R组持续输注瑞芬太尼0．1μg·kg·min^-1,F组不再追加芬太尼,两组均吸入异氟醚辅助麻醉。监测不同时点（插管前、后,手术开始后5min、30min）的MAP和HR。记录停止吸入麻醉药至拔管的时间,苏醒后是否再入睡及麻醉效果（以患儿术中MAP、HR监测值和同一术者的评价综合评分）。结果两组病人插管前、插管后、手术开始后5min的MAP和HR无显著差异,R组手术开始后30min的HR低于F组（P〈0．05）,苏醒时间短于F组（P〈0．05）,苏醒后再入睡率低于F组（P〈0．05）,麻醉满意度高于F组（P〈0．05）。结论瑞芬太尼用于小儿腺样体刮除、腺扁摘除术,能保证稳定的血流动力学状态,苏醒快速,效果满意。     

瑞芬太尼对小儿等离子刀扁桃体腺样体切除术应激反应的影响

目的 观察瑞芬太尼麻醉对小儿等离子刀扁桃体、腺样体切除术中血流动力学和血皮质醇（Cos）的影响.方法 选择60例ASA Ⅰ～Ⅱ级拟行扁桃体、腺样体切除术的患儿,随机分为实验组（瑞芬太尼复合异丙酚）和对照组（芬太尼复合异丙酚）,每组各30例.分别于麻醉前5 min（T1）、气管插管前（T2）、气管插管时（T3）、腺样体切除时（T4）以及手术结束时（T5）自静脉采血.采用放射免疫法测定血浆Cos水平,记录两组收缩压（SBP）、舒张压（DBP）及心率（HR）的变化,观察呼吸恢复时间、苏醒时间、拔管时间及术后不良反应的发生情况.结果 麻醉期问实验组血流动力学明显较对照组稳定;对照组气管插管后各时点Cos高于实验组（P＜0.01）,实验组各时点Cos无明显改变（P＞0.05）.实验组术后呼吸恢复时间、苏醒时间、拔管时间明显早于对照组（P＜0.01）,不良反应的发生率明显低于对照组（P＜0.01）.结论 与芬太尼相比,瑞芬太尼复合异丙酚全凭静脉麻醉可有效降低应激引起的内分泌反应,血流动力学更稳定.术后苏醒快,不良反应发生率低,用于小儿等离子刀扁桃体、腺样体切除手术具有明显的优越性.     

Comparison of the Effect of Fentanyl,Sufentanil, Alfentanil and Remifentanil on Cardiovascular Response to Tracheal Intubation in Children

Objective

Laryngoscopy and tracheal intubation may cause significant cerebral and systemic hemodynamic responses. Many drugs have been shown to be effective in modifying these hemodynamic responses, including fentanyl, sufentanil, alfentanil and remifentanil. The purpose of the current study was to compare the efficacy of fentanyl, sufentanil, alfentanil and remifentanil on blunting cardiovascular changes during laryngoscopy and intubation in children.

Methods

Eighty children, 1–6 years old, classified as American Society of Anesthesiologists physical status I and II who were scheduled for elective surgery with general anesthesia and orotracheal intubation, were enrolled in this randomized and double-blinded study. Patients were randomly assigned into four groups of 20 patients. Group F received fentanyl 1µg/kg⁻¹, group S received sufentanil 0.1 µg/kg⁻¹, group A received alfentanil 10 µg/kg⁻¹ and group R received remifentanil 1 µg/kg⁻¹ intravenously. After establishment of neuromuscular blockade confirmed with a nerve stimulator, laryngoscopy and orotracheal intubation were performed 3 min after induction. Hemodynamic variables including systolic and diastolic blood pressure (SAP, DAP) and heart rate (HR) were recorded at base line (before opioid administration), before laryngoscopy and one minute after orotracheal intubation.

Findings

The patients'' characteristics and laryngoscopy grade were similar in all groups. There was no significant difference in the mean values of SAP, DAP and HR at each measured time between the four groups. There was significant difference in the mean values of SAP, DAP and HR measured over time in each group.

Conclusion

The intravenous fentanyl attenuated laryngoscopy-induced SAP, DAP and HR increases better than sufentanil, alfentanil or remifentanil and hemodynamic stability is better preserved with fentanyl.     

IFN-γ+874基因单核苷酸多态性与宫内HBV感染易感性关系的研究

目的　研究宫内乙型肝炎病毒 (HBV)感染患儿的干扰素γ(IFN γ) 874单核苷酸多态性 (SNP)与宫内HBV感染易感性的关系 ,探讨宫内HBV感染的遗传易感因素。方法　母亲为HBV携带者 ,新生儿出生后按程序使用乙肝疫苗或乙肝疫苗联合乙肝免疫球蛋白进行免疫。出生时外周静脉血HBsAg和 (或 )HBV DNA阳性并持续阳性 6个月以上者为宫内HBV感染组 ,共 4 6例。出生时及以后随访中未曾出现过HBsAg或HBV DNA阳性 ,1岁时抗HBs达保护滴度以上者为正常免疫组 ,共73例。用ABIPrism770 0高通量荧光PCR系统对IFN γ 874SNP进行测定。结果　宫内HBV感染组IFN γ 874AA、AT和TT基因型分布频率分别为 6 7 4 %、19 6 %和 13 0 % ;正常免疫组AA、AT和TT基因型分布频率分别为 4 5 2 %、30 1%和 2 4 7%。两组IFN γ 874基因型的分布频率差异有显著性 (χ2=5 10 2 ,P <0 0 5 )。宫内HBV感染儿童IFN γ 874AA基因型占优势。结论IFN γ 874基因多态性与宫内HBV感染有关 ,提示IFN γ 874基因多态性可能在决定个体宫内HBV感染遗传易感性方面有一定意义     

镇痛镇静策略在PICU机械通气患儿中的应用

目的探讨不同镇静、镇痛策略对机械通气患儿的辅助治疗效果及不良反应。方法将80例进行机械通气且需镇静镇痛治疗的危重患儿随机分为咪达唑仑组(40例)和瑞芬太尼+咪达唑仑组(40例),采用Ramsay及FLACC量表评估镇静、镇痛效果,记录治疗期间生命体征、呼吸机参数动态变化、脏器功能指标、瑞芬太尼及咪达唑仑应用总量、机械通气时间、PICU住院时间及费用、不良反应发生情况等。结果 2组患儿均能达到满意镇痛镇静效果。与咪达唑仑组比较,瑞芬太尼+咪达唑仑组达到镇静镇痛效果所需时间更短,Ramsay评估3~4级所占百分比增高,咪达唑仑用量降低,差异均有统计学意义(P0.05)。2组患儿治疗后心率、平均动脉压及自主呼吸频率均降低,但瑞芬太尼+咪达唑仑组在用药后3~24 h的心率、3~12 h的平均动脉压和自主呼吸频率下降更明显(P0.05)。与咪达唑仑组比较,瑞芬太尼+咪达唑仑组患儿用药后的6 h和12 h呼吸机潮气量及经皮氧饱和度均明显增高,呼气末二氧化碳水平明显降低,差异有统计学意义(P0.05)。瑞芬太尼+咪达唑仑组停药至苏醒的时间、拔管时间、机械通气以及PICU住院时间均明显低于咪达唑仑组(P0.05)。2组患儿PICU住院费用、不良反应发生率以及用药前后肝肾功能差异均无统计学意义(P0.05),但空腹血糖比镇静前明显降低(P0.05)。结论 PICU机械通气患儿采用瑞芬太尼+咪达唑仑治疗方案能迅速达到镇痛、镇静目标,改善通气效果,减少镇静剂用量,耐受性良好。     

Remifentanil and propofol for weaning of mechanically ventilated pediatric intensive care patients

Mechanically ventilated pediatric intensive care patients usually receive an analgesic and sedative to keep them comfortable and safe. However, common drugs like fentanyl and midazolam have a long context sensitive half time, resulting in prolonged sedation and an unpredictable extubation time. Children often awake slowly and struggle against the respirator, although their respiratory drive and their airway reflexes are not yet sufficient for extubation. In this pilot study, we replaced fentanyl and midazolam at the final phase of the weaning process with remifentanil and propofol. Twenty-three children aged 3 months–10 years were enrolled. Remifentanil and propofol revealed throughout excellent or good weaning conditions with rapid transition from hypnosis to the development of regular spontaneous breathing, airway protective reflexes, and an appropriate level of alertness. Extubation time following discontinuation of the remifentanil and propofol infusion was only 24 ± 20 min (5–80 min). We conclude that the combination of remifentanil and propofol is a promising option to improve the weaning conditions of pediatric intensive care patients. Randomized controlled trials are needed to compare remifentanil and propofol with conventional weaning protocols.     

Morphine versus remifentanil for intubating preterm neonates

A double-blind, randomised controlled study was conducted to evaluate the intubation conditions in 20 preterm neonates following the use of either morphine or remifentanil as premedication. The findings suggest that the overall intubation conditions were significantly better (p=0.0034) in the remifentanil group than in the morphine group. No severe complications were observed in either group.     

Sedative preference of families for lumbar punctures in children with acute leukemia: propofol alone or propofol and fentanyl

Propofol is a common sedative/anesthetic used for invasive procedures in children with cancer. The purpose of this study was to determine whether families of children with acute leukemia prefer propofol alone or propofol plus fentanyl for lumbar puncture (LP) sedation. We conducted a randomized, placebo controlled, double blind, crossover study. Each patient was studied twice, once with propofol/placebo and once with propofol/fentanyl. Data collected included the modified Yale Preoperative Anxiety Score (M-YPAS) at baseline and after placebo or fentanyl, Induction Compliance Checklist, recovery excitement, recovery time, and adverse events. After the study, families were asked which sedative regimen they preferred for future LPs. Twenty-two patients received 44 LP sedations: propofol 22, propofol/fentanyl 22. The average age was 6.4+/-4.2 years (mean+/-SD). There were no significant differences between groups in M-YPAS, Induction Compliance Checklist or recovery excitement. Adverse events occurred in 11/22 patients (50%) propofol and 4/22 (18.2%) propofol/fentanyl (P=0.0196). Average recovery time (mean+/-SD) was 36.86+/-17.1 minutes propofol versus 26.36+/-16.4 minutes propofol/fentanyl (P=0.047). Sixteen families (72.7%) chose propofol with fentanyl for future LP sedations (P=0.05). In conclusion, most families prefer propofol and fentanyl for LPs. Propofol with fentanyl was also associated with fewer adverse events and faster recovery.     

Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: propofol dosing and adverse events

OBJECTIVE: We sought to determine whether the combination of propofol and fentanyl results in lower propofol doses and fewer adverse cardiopulmonary events than propofol and placebo for lumbar puncture in children with acute hematologic malignancies. DESIGN: Randomized, controlled, double blind, crossover study. SETTING: Pediatric Sedation Program. PATIENTS: Children with acute leukemia or lymphoma receiving sedation for lumbar puncture. INTERVENTIONS: Each patient received two sedations in random order, one with propofol/placebo and one with propofol/fentanyl. The study investigator and patient/parent were blinded to placebo or fentanyl. Data collected included patient age and diagnosis, propofol dose and adverse events. Adverse events included oxygen saturation <94%, airway obstruction, apnea, hypotension, and bradycardia (<5% mean for age). Logistic regression analysis was used to assess probability of adverse events and the Wilcoxon Signed Rank and McNemar's tests were used for paired comparisons. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients were enrolled. Fourteen patients were male and eight were female. Each patient was studied twice for a total of 44 sedations. The median age was 5.0 yrs (range, 2.2-17.2 yrs). All procedures were successfully completed. The median total dose of propofol was 5.05 mg/kg (range, 2.4-10.2 mg/kg) for propofol/placebo vs. 3.00 mg/kg (range 1.4-10.5 mg/kg) for propofol/fentanyl (p < 0.001). Twelve adverse events occurred in 11 of 22 patients (50.0%) propofol/placebo compared with 6 of 22 (18.2%) propofol/fentanyl (p = 0.02). The most common adverse event was hypotension. CONCLUSIONS: The combination of propofol and fentanyl vs. propofol alone for lumbar puncture sedation in children with acute hematologic malignancies resulted in lower propofol doses and fewer adverse events.     

Sedation for cardiac catheterization: A controlled study

Summary In a double-blind study we compared the effectiveness of a meperidine-promethazine-chlorpromazine combination (drug A) and a fentanyl citrate-droperidol combination (drug B) as sedatives for cardiac catheterization and angiography. The doses for drug A were meperidine, 1.84 mg/kg; promethazine, 0.46 mg/kg; and chlorpromazine, 0.46 mg/kg; for drug B they were fentanyl citrate, 1.25μg/kg; and droperidol, 62.5μg/kg. Drug A or B was assigned at random to each of 94 patients aged 3 to 34 years admitted for cardiac catheterization and was given intramuscularly 30 minutes before catheterization. Each patient who required additional sedation was given intravenously (IV) one fourth of the original dose of the same medication used for initial sedation. If still further sedation was required, diazepam, 1 to 2 mg IV, was administered. The effectiveness of sedation or need for additional medication in the group who received drug A were not significantly different from those in the group who received drug B: supplemental sedation was required in 8 of 47 (17%) with drug A and 8 of 47 (17%) with drug B. No significant differences between the two groups were noted for the mean values of heart rate, respiratory rate, oxygen consumption, cardiac index, left ventricular end-diastolic pressure, arterial oxygen saturation, pH,Po ₂, andPco ₂ measured during catheterization. No side effects were observed in either group, and all patients had a steady, uneventful recovery. We conclude that the meperidine-promethazine-chlorpromazine and the fentanyl-droperidol combinations were equally effective for precatheterization sedation with the dose used. Supported in part by grants HLB 5885 and HLB 10436 from the National Institutes of Health, Bethesda, Maryland     

IL-19基因多态性与儿童乙型肝炎病毒易感性研究

目的 探讨白介素19（IL-19）基因的单核苷酸多态性（SNP）与儿童乙型肝炎病毒（HBV）易感性的关系。方法 采用病例对照研究,收集HBsAg阳性儿童136例（病例组）,HBsAg阴性的健康儿童297例（对照组）,应用PCR 聚合酶链反应和DNA测序法进行基因分型。结果 IL-19基因的rs1798位点的基因型在病例组和对照组人群中频率分布差异有统计学意义,病例组的CG 基因型的比例显著高于对照组（P < 0.05）;IL-19基因的rs2243191位点的基因型和等位基因在HBV感染高危儿童感染组和未感染组人群中频率分布差异有统计学意义,感染组TC、CC基因型以及C等位基因的比例显著高于未感染组（P < 0.05）。结论 IL-19 基因SNP 位点rs1798的基因多态性可能与儿童乙型肝炎易感性相关;rs2243191的基因多态性可能与HBV感染高危儿童突破感染易感性相关。