咪唑安定对小儿氯胺酮麻醉效应的影响

小儿氯胺酮麻醉在基层小儿手术中应用较为广泛 ,为了增强麻醉效果 ,减少副作用 ,临床上常与咪唑安定复合应用。本组通过观察不同剂量咪唑安定对氯胺酮麻醉效应的影响 ,观察咪唑安定的适用量 ,为临床应用提供依据。1　资料与方法1 1　选择ＡＳＡⅠ—Ⅱ级 ,年龄 5月～ 9岁小儿患者 10 0例 ,男 72例 ,女 2 8例。腹股沟斜疝 34例 ,隐睾 2 8例 ,斜颈 2 2例 ,精索静脉曲张 16例。体重 5～ 32 (17.83± 4.33)ｋｇ ,手术时间 2 0～ 85 (38.42± 10 .2 3)ｍｉｎ。所有患者术前30ｍｉｎ肌注阿托品 0 .0 2ｍｇ/ｋｇ。以氯胺酮 (Ｋ) (4～ 6 )ｍｇ/ｋｇ肌…     

咪唑安定和氯胺酮复合麻醉用于小儿眼科手术

眼科手术多在局麻下进行 ,而小儿患者由于不合作常需全身麻醉 ,我们采用咪唑安定和氯胺酮复合麻醉 ,取得了满意的效果 ,现报告如下。1　临床资料选择小儿眼科手术 32例 ,ＡＳＡⅠ～Ⅱ级 ,男 2 0例 ,女 12例 ;年龄 4个月～ 12岁 ,体重 (18.2 5± 8.2 8)ｋｇ。手术包括白内障摘除人工晶体植入术 2 5例 ,斜视矫正术 3例 ,眶内肿瘤摘除术 1例 ,眼球摘除术 1例 ,眼部外伤清创缝合术 2例。术前心肺及各项化验检查正常。手术时间为 5 0～ 140ｍｉｎ。2　麻醉方法术前 0 .5ｈ肌注阿托品 0 .0 1～ 0 .0 2ｍｇ·ｋｇ-1,安定 0 .2～0 .4ｍｇ·ｋｇ-1。…     

咪唑安定加异丙酚对氯胺酮全麻精神副作用的影响

氯胺酮镇痛强、诱导快、器官毒性小、重复运用 ,是临床上常用的静脉麻醉药 ,但精神副作用发生率较高。咪唑安定与异丙酚复合应用具有协同性很强的镇静、催眠、镇吐、顺应性遗忘及抗惊厥作用[1 ] 。我们用其消除氯胺酮全麻病人术后精神副作用 ,收到了良好的效果。1　资料与方法1 .1一般资料 :4 0例行烧伤切痂植皮手术 (烧伤面积 1 0 %～80 % )病人中 ,男 36例 ,女 4例 ,年龄 30～ 5 5岁 ,体重 4 5～ 70kg,手术时间 (5 .5± 1 .2 5 )h。术前 30min肌注哌替啶 5 0mg、异丙嗪 2 5mg、阿托品 0 .5mg。ASAⅠ～Ⅱ级。1 .2　方法 :根据术中所给药…     

咪唑安定氯胺酮用于婴幼儿门诊诊疗麻醉处理

对于门诊行MRI、γ-刀,钴-60放疗及介入治疗的婴幼儿患者,由于治疗过程的特殊要求,术中生命体征的全面监测极为困难。在麻醉性监护(Monistored Anesthesia Care,MAC)过程中如何合理用药,对于减少麻醉风险及保证麻醉效果都至关重要。就氯胺酮及咪唑安定在婴幼儿患者检查中的应用     

咪唑安定复合氯胺酮防止阑尾牵拉反应55例临床观察

阑尾切除术中常伴有不同程度的牵拉反应 ,严重时可影响手术的顺利进行。我们将咪唑安定和氯胺酮联合应用于硬膜外阻滞下阑尾切除术的牵拉反应 ,取得了一定的效果。现报告如下。1　资料和方法患者 5 5例 ,其中男 32例 ,女 2 3例 ,年龄 18～ 5 8岁。术前用药相同。穿刺点均为Ｔ12 ～Ｌ1间隙 ,用 1 6 %利多卡因 +0 2 %丁卡因行持续硬膜外麻醉 ,麻醉平面Ｔ6以下。 5 5例随机分 3组 :Ⅰ组为对照组 ,共 15例 ,于切皮前 1ｍｉｎ静注生理盐水 5ｍｌ,术中不加任何辅助药 ;Ⅱ组为咪唑安定组 ,共 2 0例 ,将咪唑安定稀释后于切皮前 1ｍｉｎ静脉缓注 0 …     

小剂量氯胺酮、咪唑安定防治硬膜外阻滞下内脏牵拉反应的观察

在硬膜外阻滞下应用小剂量咪唑安定、氯胺酮于腹腔手术 ,防治牵拉反应 ,并与芬太尼、氟哌啶 (氟芬合剂 )进行对比观察 ,取得了满意的临床效果 ,现报道如下。1　资料与方法1.1　一般资料 :选择连续硬膜外阻滞麻醉下行腹部手术病人 ,将麻醉阻滞效果良好 ,阻滞平面在Ｔ3 -Ｔ4～Ｔ12 Ｔ1资料完整的 30 0例 ,其中男 14 8例 ,女 15 2例 ,年龄 16～ 6 2岁 ,平均(43± 11.5 2 )岁 ,ＡＳＡⅠ -Ⅱ级 ,随机分为两组 ,Ⅰ组为咪氯组16 6例 ,Ⅱ组为氟芬组 134例。1.2　麻醉方法 :术前 1ｈ肌注安定 10ｍｇ ,阿托品 0 .5ｍｇ ,常规连续硬膜外阻滞 ,头端内置…     

咪唑安定和氯胺酮在小儿骨折手法整复中的应用

目的:观察小儿骨折手法复位选用咪唑安定与氯胺酮合用的麻醉效果。方法:术前静脉给予咪唑安定(0.05～0.1)mg/kg和氯胺酮(1～2)mg/kg,术中每隔15～20min给予氯胺酮(1～2)mg/kg和咪唑安定(0.05～0.1)mg/kg以维持麻醉;麻醉起效后在X线透视下行手法整复骨折复侠后以夹板固定4～8w后,去夹板行伤肢功能康复。结果:50例骨折中手法整复中镇静镇痛效果优良率达96%,对MAP、HR、RR和SPO2影响轻微。结论:两药合用对小儿麻醉起效快,镇静镇痛效果好,术中血压、心率平稳,无明显呼吸抑制现象,小儿骨折手法复位效果好。     

术前肌注咪唑安定和芬太尼产生遗忘作用的临床观察

咪唑安定具有遗忘作用,但临床应用时其遗忘率较低,加大用量则加深镇静。本文就咪唑安定和芬太尼术前肌注所产生的遗忘作用进行观察。报告如下。     

氯胺酮复合咪唑安定辅助骶管麻醉在小儿腹部以下手术中的应用

目的 探讨氯胺酮复合咪唑安定辅助骶管麻醉在小儿腹部以下手术中的应用价值。方法 80例5岁以下行腹部以下手术患儿随机分为氯胺酮组（K组）和氯胺酮复合咪唑安定辅助骶管麻醉组（KDS组）各40例。术中全程观察平均动脉压（MAP）、心率（HR）、血氧饱和度（SPO2）、呼吸频率（R）、氯胺酮用量、麻醉效果并记录清醒时间、术中术后不良反应。结果 KDS组在肌注氯胺酮5分钟后MAP、HR与注药前相比有统计学差异,静注咪唑安定及骶管麻醉后MAP、HR逐渐降低,但与术前无统计学差异。K组患儿切皮及手术开始10分钟所测MAP、HR处于较高水平,与术前相比有统计学差异,P〈0.01。切皮与术中相比患儿呼吸有统计学差异,P〈0.05。SPO2两组间及各组与术前无统计学差异,P〉0.05,氯胺酮用量有统计学差异,P〈0.01。结论 氯胺酮复合咪唑安定辅助骶管麻醉,效果满意,呼吸循环也较稳定,术后清醒快,清醒质量高,围术期安全性高,优于单纯氯胺酮麻醉,是小儿腹部以下手术的一种理想麻醉。     

氯胺酮加咪唑安定复合局部麻醉下行小儿四肢手术

目的：观察局部麻醉下行小儿四肢手术,术中辅用氯胺酮（Ketamin,K）和小剂量咪唑安定（Midazolam,M）强化麻醉,观察其麻醉效果和术后并发症。方法：选择期80例四肢手术患儿,年龄3~11岁,其中上肢60例均分为A组和B组,下肢20例均分为C组和D组。4组患儿入室后先肌注K4~6 mg/kg、建立静脉通道、连接监护仪,A、B组行腋路臂丛阻滞,C、D组行连续硬膜外阻滞,开始手术前2 min A、C组缓慢静注咪唑安定0.075 mg/kg,4组患儿术中据情静注氯胺酮1~2 mg/kg,手术结束前20 min停止静脉给药。观察并记录生命体征,比较麻醉效果、氯胺酮用量、术后苏醒时间和术后并发症。结果：A、C组术中生命体征较B、D组平稳,麻醉效果也较好,且氯胺酮用量和术后并发症也少。结论：局部麻醉加氯胺酮强化麻醉再辅助少量咪唑安定行小儿四肢手术,其麻醉效果好,术后并发症少。     

咪达唑仑复合氯胺酮应用于小儿基础麻醉的临床探讨

 目的 探讨应用咪达唑仑复合氯胺酮不同给药方法在小儿基础麻醉中的优化方案.方法 200例1～6岁,ASAⅠ～Ⅱ级患儿随机分成以下五组:A组为口服咪达唑仑0.7 mg/kg;B组为口服氯胺酮8 mg/kg;C组为肌注氯胺酮5mg/kg;D组为口服咪达唑仑0.5 mg/kg和氯胺酮4 mg/kg;E组为先口服咪达唑仑0.5 mg/kg,再肌注氯胺酮4 mg/kg.观察各组诱导结果及呼吸循环变化、不良反应.结果 ①A组与B组比较,A组起效更快(P<0.01),合作更好,不良反应较少;②A组、B组均比C组更合作,但不如C组起效更快;③D组和E组相比,患儿更合作,不良反应更少,但起效更慢,两组诱导效果无显著差异(P>0.05).结论 咪达唑仑复合氯胺酮优于单独给药,对循环呼吸影响小;口服给药可行性更佳.     

Propulsion strategy in running in children and adolescents with cerebral palsy

BackgroundRunning is a fundamental movement skill important for participation in physical activity. Children with cerebral palsy (CP) who are classified at Gross Motor Function Classification Scale (GMFCS) level I and II are able to run but may be limited by neuromuscular impairments.Research questionTo describe the propulsion strategy (PS) during running of children and adolescents with CP.MethodsThis cross-sectional study used kinematic and kinetic data collected during running from 40 children and adolescents with unilateral or bilateral CP and 21 typically developing (TD) children. Maximum speed, peak ankle power generation (A2), peak hip flexor power generation in swing (H3) and PS (PS = A2/(A2 + H3)) were calculated. Linear mixed models were developed to analyze differences between groups.ResultsMaximum speed, A2 and PS were significantly less in children with CP GMFCS level I than in TD children and significantly less in children in GMFCS level II than level I. For children with CP, A2 and PS were significantly smaller in affected legs than non-affected legs. In affected legs, H3 was significantly larger in children in GMFCS level II than GMFCS level I but not different between TD children and children in GFMCS level II.SignificanceThe contribution of ankle plantarflexor power to forward propulsion in running is reduced in young people with CP and is related to GMFCS level. This deficit appears to be compensated in part by increased hip flexor power generation but limits maximum sprinting speed.     

Single-session reliability of discrete gait parameters in ambulatory children with cerebral palsy based on GMFCS level

The single-session reliability of 28 discrete spatiotemporal and kinematic variables was evaluated from computerized gait analysis (CGA) in 33 ambulatory children with cerebral palsy (CP), subcategorized according to Gross Motor Function Classification System (GMFCS) Levels I (n = 11), II (n = 12) and III (n = 10). Nineteen boys and 14 girls participated, mean age = 8 years 1 month (S.D. = 3 years 0 month). Intraclass correlation coefficients (ICCs) estimated reliability, and the number of strides required to obtain an ICC of at least 0.90 was determined. The reliability of discrete gait parameters was dependent upon GMFCS level, with children in GMFCS Level I exhibiting the highest reliability (ICC range = 0.70–0.96). GMFCS Levels II and III had lower levels of reliability with ICC values varying from 0.54 to 0.95 and 0.45 to 0.98, respectively. With the exclusion of pelvis range of motion (ROM), an average of four strides provided a reliability estimate of at least 0.90 for GMFCS Level I, while six strides were needed for children in Levels II and III. On the basis of the intrasession reliability results from the present study, further work is recommended to examine the test–retest reliability of these gait parameters in children with CP.     

Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole

The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0 cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe + sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.     

Causes of out-toeing gait in children with cerebral palsy

Background: Out-toeing is common in children with cerebral palsy (CP), contributing to lever arm dysfunction and functional limitations. It is important to determine the cause(s) of out-toeing prior to treatment, whether surgical or non-surgical.Research Questions: What are the contributors to out-toeing in children with CP and do they differ between children with bilateral and unilateral involvement?Methods: The causes of out-toeing gait were determined retrospectively, with the use of computerized gait analysis, in 261 children with cerebral palsy (344 sides). The prevalence of various causes was calculated separately for children with bilateral and unilateral involvement, and compared statistically between groups using Fisher’s Exact analysis.Results: The most common cause of out-toeing was pes valgus in bilaterally involved subjects (71%) and pelvic external rotation (64%) in unilaterally involved subjects. Over half of the cases of out-toeing were due to multiple causes: 62% of the unilateral group and 53% of the bilateral group. In limbs with multiple causes of out-toeing in the bilateral group, pes valgus was one of the causes in 91% of limbs (146/161), and was most commonly combined with hip external rotation (27%), pelvic external rotation (22%), or external tibial torsion (20%). For the unilateral group with multiple causes of out-toeing, pelvic external rotation was one of the causes in 83% of limbs (20/24) and hip external rotation in 63% (15/24). Both were present (with or without additional causes) in 46% (11/24) of such limbs.Significance: The causes of out-toeing are multifactorial in over half of affected limbs of children with cerebral palsy. They also differ for children with bilateral and unilateral involvement. These findings should be carefully considered prior to non-surgical or surgical treatment of out-toeing gait in these patients, to allow all sites of pathology to be addressed, and to optimize outcomes.     

脑性瘫痪儿童的影像学特征

目的脑性瘫痪的诊断主要靠临床表现，而影像学检查（头颅CT及MRI）对脑瘫的诊断及脑病变的判定起重要作用。痉挛型双瘫以脑室周围白质软化症（PVL）为主，不随意运动型表现为基底病变或PVL，失调型表现为先天性小脑发育不良，偏瘫型主要突出在对侧单侧脑损伤。利用影像学检查（头颅CT及MRI）有助于脑瘫的诊断及脑病变的判定，为脑瘫儿童的治疗或改善预后提供可靠依据。     

Reliability and validity of the gait classification system in children with cerebral palsy (GCS-CP)

BackgroundGait classification systems (GCS) may enable clinicians to differentiate gait patterns into clinically significant categories that assist in clinical decision-making and assessment of outcomes. Davids and Bagley in 2014 [1] described a GCS for children with cerebral palsy (GCS-CP). The purpose of our study was to use the GCS-CP for the first time on a sample of patients with CP and to evaluate the reliability and utility of the classification system.MethodsThe gait of 131 children with CP was retrospectively reviewed and classified according to Davids and Bagley’s classification using two-dimensional (2D) video and three-dimensional (3D) lower limb kinematics and kinetics. Gross Motor Function Classification System (GMFCS) levels were determined, and the Gait Profile Scores (GPS) calculated to characterize the sample concerning gait classification. The comparison between the groups was performed using the Kruskal-Wallis test with respect to the non-normal distribution of the data. The intrarater and interrater reliability was determined using the Kappa index (k) statistics with 95% CI.ResultsAll GCS-CP groups were represented within the evaluated sample. Of the 131 cases evaluated, 127 (96.95%) were able to be classified with respect to sagittal plane stance phase gait deviations. All patients in the sample were able to be classified with respect to sagittal plane swing phase and transverse plane gait deviations. The interrater reliability was 0.596 and 0.485 for the first and second levels of the classification, respectively, according to the Fleiss’s Kappa statistics. Intrarater reliability was 0.776 and 0.714 for the raters one and two, respectively, according to the Cohen’s Kappa statistics.SignificanceThe GCS-CP exhibited clinical utility, successfully classifying almost all subjects with CP in two planes, based upon kinematic and kinetic data. The classification is valid and has moderate interrater and moderate to substantial intrarater reliability.     

Balance control in gait children with cerebral palsy

This study sought to highlight the balance control process during gait in children with cerebral palsy (CP) by analyzing the different strategies used in order to generate forward motion while maintaining balance. Data were collected using a motion analysis system in order to provide a clinical gait analysis for 16 children with CP and 16 children with typical development. Significant differences between the two groups are observed in terms of kinetic data of the propulsive forces of the center of mass (COM) and of the center of pressure (COP) dynamic trajectory and for locomotor parameters. The imbalance generated by divergent trajectories of COM and COP produce the propulsive forces responsible for human gait initiation. Moreover, we observe in children with CP an “en bloc” postural strategy resulting in increasing divergence between trajectories of COM–COP. This particular strategy of the children with CP is characterized by a greater time duration between the moment of COM–COP trajectory divergence and the moment where the forward propulsive forces became apparent.     

Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: Preliminary results of a self-controlled study

BackgroundChildren with cerebral palsy (CP) may have difficulties under dual-task conditions. Spatiotemporal gait parameters have deteriorated with concurrent tasks in children with CP. However, how dual-task training affects gait parameters in children with spastic diplegic CP has not been clarified.Research questionHow does dual-task training program effect gait, functional skills, and health-related quality of life in children with spastic diplegic CP?MethodsEleven children with spastic diplegic CP (median age 11 y, range 7–16 y; 4 female; 7 male) Gross Motor Function Classification System level 1–2 and obtained 27 and higher scores from Modified Mini Mental Test included in the study. The study was planned as a self-controlled clinical research design. Children were recruited to conventional physiotherapy program for 8 weeks and dual-task training program added to conventional physiotherapy program for following 8 weeks. Children were evaluated at baseline, after conventional physiotherapy program, and after dual-task training program. Children’s gait was evaluated with Zebris™ FDM-2 device and Edinburgh Visual Gait Score, functional mobility skills with 1 min Walk Test (1MWT), and health-related quality of life with the Pediatric Quality of Life Inventory (PedsQL) - CP module.ResultsThe difference in step length, step time, stride time, cadence and gait speed of spatiotemporal parameters of gait during dual-task performance were found statistically significant in children with spastic diplegic CP, after dual-task training program (p < 0,05). After dual-task training, statistically significant gains were found in 1MWT, movement and balance subtitle of PedsQL-CP module Parent Form (p < 0,05).SignificanceDual-task training program added to a conventional physiotherapy program provides more gains in terms of functionality of children with spastic diplegic CP will contribute to the improvement of the motor functional level.     

Effectiveness of interactive computer play on balance and postural control for children with cerebral palsy: A systematic review

BackgroundInteractive computer play (ICP) becomes popular in rehabilitation for children with cerebral palsy (CP). With the nature of ICP, it could be an effective intervention specifically to improve balance and postural control for children with CP. The present paper aimed to review the effectiveness of ICP on postural control and balance for children with CP.MethodsElectronic databases including Medline, AMED, EBSCOhost, PsycINFO, Embase, the Cochrane Library and the DARE were searched up to September 2018. Studies were included if (1) participants were aged under 18 and had CP, (2) ICP intervention was performed, (3) an explicit objective was postural control and balance of the participants, and (4) results were fully published in English-language peer-reviewed journals. Characteristics of study participants, ICP protocols and study results were extracted. Level of evidence of each studies was graded using the guidelines from the American Academy of Cerebral Palsy and Developmental Medicine. Methodological quality was graded using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes were calculated on available data.ResultsTwenty studies were included, with nine of level I or II evidence. Most studies had fair methodological rigor. Huge variations in the study designs and protocols of ICP were found among the studies.ConclusionsICP seemed to be more effective than conventional therapy in improving postural control and balance, with medium to large effect sizes for children with mild to moderate severity of CP. Future studies of high methodological rigour are required to verify the role of on-site guidance of the children during ICP and the effect on children with more severe CP.