CAJ | 학술논문

目的探讨表面麻醉下早产儿视网膜病(ROP)激光治疗术治疗前后血浆多巴胺、去甲肾上腺素、皮质醇、C-反应蛋白(CRP)、心率、呼吸频率和平均动脉压的变化,为制定管理规范和干预措施提供指导.方法选取2012年5月至12月在广州市妇女儿童医疗中心实施表面麻醉下激光光凝治疗的ROP忠儿30例.在激光治疗术前、治疗术结束时、治疗后1h、治疗后24 h4个时间点抽取30例ROP忠儿静脉血,采用放射免疫分析法检测血浆多巴胺、去甲肾上腺素、皮质醇和CRP水平,并记录上述4个时间点30例患儿的心率、呼吸频率和平均动脉压的数值.结果与激光治疗前安静状态比较,患儿多巴胺、去甲肾上腺素、皮质醇水平在治疗结束时、治疗后1h均显著增高,差异均有统计学意义(t=6.39、2.55;t=7.74、2.91;t=8.87、2.15;P均＜0.05);CRP在治疗结束时、治疗后1h、治疗后24 h与治疗前水平相比,差异均无统计学意义(t=0.06、0.89、1.16,P均＞0.05).心率和呼吸频率在治疗结束时、治疗后1h、治疗后24 h的水平与治疗前安静状态相比,差异均有统计学意义(t=4.33、3.84、3.38;t=6.81、4.42、2.96;P均＜0.05),治疗结束时患儿平均动脉压与治疗前安静状态相比,差异具有统计学意义(t=6.10,P＜0.001).结论接受激光治疗的ROP忠儿会产生应激反应,临床医护工作者应当重视对表面麻醉下视网膜激光光凝术早产儿心率和呼吸等的监测并及时采取应对措施,以减轻应激反应.
목적 탐토표면마취하조산인시망막병(ROP)격광치료술치료전후혈장다파알、거갑신상선소、피질순、C-반응단백(CRP)、심솔、호흡빈솔화평균동맥압적변화,위제정관리규범화간예조시제공지도.방법 선취2012년5월지12월재엄주시부녀인동의료중심실시표면마취하격광광응치료적ROP충인30례.재격광치료술전、치료술결속시、치료후1h、치료후24 h4개시간점추취30례ROP충인정맥혈,채용방사면역분석법검측혈장다파알、거갑신상선소、피질순화CRP수평,병기록상술4개시간점30례환인적심솔、호흡빈솔화평균동맥압적수치.결과 여격광치료전안정상태비교,환인다파알、거갑신상선소、피질순수평재치료결속시、치료후1h균현저증고,차이균유통계학의의(t=6.39、2.55;t=7.74、2.91;t=8.87、2.15;P균＜0.05);CRP재치료결속시、치료후1h、치료후24 h여치료전수평상비,차이균무통계학의의(t=0.06、0.89、1.16,P균＞0.05).심솔화호흡빈솔재치료결속시、치료후1h、치료후24 h적수평여치료전안정상태상비,차이균유통계학의의(t=4.33、3.84、3.38;t=6.81、4.42、2.96;P균＜0.05),치료결속시환인평균동맥압여치료전안정상태상비,차이구유통계학의의(t=6.10,P＜0.001).결론 접수격광치료적ROP충인회산생응격반응,림상의호공작자응당중시대표면마취하시망막격광광응술조산인심솔화호흡등적감측병급시채취응대조시,이감경응격반응.
Objective To investigate the alterations of dopamine,norepinephrine,cortisol,C-reactive protein (CRP),heart rate (HR),respiratory rate (RR) and mean artery pressure (MAP) before and after the laser photoeoagulation for retinopathy of prematurity (ROP) with topical anesthesia and to provide the guideline for improving its routine management and interventions.Methods Thirty children with ROP who received ROP laser photocoagulation in Guang zhou Women and Children's Medical Center from May to Dec.2012 were selected.The blood of the 30 cases of infants were collected at 4 time points:before laser therapy,the end of laser therapy,1 hour and 24 hours after laser therapy.The concentrations of dopamine,norepinephrine,cortisol and CRP in plasma were measured at each time point with radio immunoassay,and the values of HR,RR and MAP of infants were recorded as well.Results The levels of dopamine,norepinephrine and cortisol at the end and 1 hour after therapy were higher than those in the quiet state before therapy,and the differences were statistically significant (t =6.39,2.55 ; t =7.74,2.91 ; t =8.87,2.15 ; all P ＜ 0.05) ; the levels of CRP at the end of therapy,1 hour and 24 hours after therapy had no statistical difference in comparison with those in quiet state before therapy (t =0.06,0.89,1.16; all P ＞ 0.05) ; the levels of HR and RR at the end of therapy,1 hour and 24 hours after therapy had statistical difference in comparison with those in the quiet state before therapy (t =4.33,3.84,3.38 ; t =6.81,4.42,2.96 ; all P ＜ 0.05).The level of MAP at the end of therapy had statisti cal difference in comparison with that in the quiet state before therapy (t =6.10,P ＜ 0.001).Conclusions Infantswho experieneed ROP laser photocoagulation had stress response.Clinicians should pay more attention to monitoring HR and RR of preterm infants receiving retinal laser photocoagulation under topical anesthesia and take active intrvventions in order to relieve the stress response.