摘要
目的通过对儿童静脉复合麻醉经皮无痛肾活检与传统局麻下肾活检的成功率和安全性进行对比研究，探讨超声引导下无痛肾活检在儿童患者的临床应用意义。方法将我科进行静脉复合麻醉无痛肾活检27例与传统局麻下肾活检23例患儿（均小于12岁）的临床与病理资料进行比较。观察两组的成功率（肾小球数大于15个或能够作出完整病理诊断为穿刺成功）和并发症。结果无痛组患儿均顺利完成穿刺，肾小球数8～49（23．3±10．0）个；局麻组肾小球数0～40（23．2±9．4）个，2例无法配合放弃穿刺，2例肾小球数低于15个，无痛组和局麻组总成功率分别为96．3％和82．6％，具显著性差异。并发症：无痛组穿刺后麻醉苏醒时间为2～5min，1例苏醒过程中发生呼吸抑制，加大吸氧和畅通呼吸道后好转，局麻组无麻醉并发症；肉眼血尿无痛组和局麻组各1例，肾周小血肿发生率分别为22．2％和21％，无显著性差异。结论儿童静脉复合麻醉肾活检安全可靠，成功率高，其病理诊断对临床治疗及预后评价具有明确的指导意义，值得推广使用。
Objective To compare the successful rate and security of percutaneous renal biopsy under transient intravenous anesthesia and traditional local anesthesia in children. Methods Clinical and pathological data of children patients （less than 12 years old） undergoing ultrasound-guided renal biopsy with intravenous anesthesia from June 1, 2006 to May 30, 2007 in our department （ Painless group） were compared with those of traditional local anaesthesia for renal biopsy from January 1, 1999 and May 30, 2006 （ local anaesthesia group）. In painless group, fentanyl citrate （50 μg for less than 60 kg in body weight, and 75 μg for those over 60 kg） were injected intravenously, then diprivan was injected intravenously till the end of lash reflex （usually 140- 150 mg）, and the puncture was performed when the child got complete narcosis. In local anaesthesia group, 2% lidocaine was applied for local anaesthesia, rapid puncture was performed when the children were asked to hold the breath. Successful rate （those getting more than 15 glomeruli） and the complications were observed. Results The punctures in painless group were done successfully with glomeruli number of 8 to 49 [ mean （23.3 ± 10. 0） ], and only 1 case got 8 glomeruli; while in local anesthesia group, the glomerulus number was 0 - 40 [ mean （23.2 ± 9.4） ] , with no difference between the 2 group. But in local anesthesia group, 2 biopsies were abandoned due to bad cooperation caused by supertension, and 2 cases obtained less than 15 glomeruli. Successful rate was 96.3% and 82.6% respectively in the 2 groups. The complications of anaesthesia in 2 groups： the analepsia time in painless group was 2 -5 rain, and respiratory depression took place in 1 case who got better soon after the oxygen intake was increased and the respiratory tract was unobstructed; 2 cases in local anesthesia group presented discomfort of chest distress, sweat, and fluster etc. which got better after rest. There was no difference in the incidence of gross hematuria and perirenal hematoma. Conclusion Compared with traditional renal biopsy in local anesthesia, transient intravenous anesthesia is safe and reliable to perform for renal biopsy in children.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2008年第5期450-452,共3页
Journal of Third Military Medical University
关键词
肾
活组织检查
儿童
静脉麻醉
局麻
renal biopsy
children
intravenous anesthesia
local anesthesia
