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脑脊液初压测量期间儿童的镇静:德国假性脑瘤患儿缺乏标准化。

Sedation of children during measurement of CSF opening pressure: lack of standardisation in German children with pseudotumor cerebri.

作者信息

Tibussek D, Distelmaier F, Kummer S, von Kries R, Mayatepek E

机构信息

Department of General Pediatrics, University Children's Hospital Duesseldorf, Germany.

出版信息

Klin Padiatr. 2012 Jan;224(1):40-2. doi: 10.1055/s-0031-1298020. Epub 2011 Dec 14.

Abstract

BACKGROUND

Diagnosis of pseudotumor cerebri (PTC) requires proper documentation of raised CSF opening-pressure. In childhood results may not be reliable due to insufficient sedation/analgesia or drug effects. We aimed to evaluate the current practice regarding pain and stress management in children undergoing lumbar puncture (LP) for pressure measurement.

METHODS

A one-year survey was conducted involving 368 German paediatric departments. All children with newly diagnosed PTC should be reported. Details analyzed here included: age, sex, CSF opening pressure and type of procedural sedation and analgesia (PSA) during LP.

RESULTS

61 patients were analyzed, aged 6 months to 17 years. 29 patients (47%) did not receive any kind of PSA. In children receiving PSA the following regimens were used: Ketamine; Midazolam; Ketamine + Midazolam; Midazolam + Piritramide; Propofol; Profofol + Midazolam; general anaesthesia.

CONCLUSION

Pain and stress management in children undergoing LP for CSF opening pressure measurement is often insufficient. Pain, stress and the variability of PSA regimen may be confounders of pressure measurement. In order to prevent false diagnoses of PTC and to obtain comparable results at different centers, a general consensus on PSA in children undergoing LP for CSF opening pressure measurements is required.

摘要

背景

假性脑瘤(PTC)的诊断需要准确记录脑脊液初压升高情况。在儿童中,由于镇静/镇痛不足或药物影响,结果可能不可靠。我们旨在评估目前在进行腰椎穿刺(LP)测量压力的儿童中疼痛和应激管理的实践情况。

方法

对368个德国儿科科室进行了为期一年的调查。所有新诊断为PTC的儿童均应上报。此处分析的详细信息包括:年龄、性别、脑脊液初压以及LP期间程序性镇静和镇痛(PSA)的类型。

结果

分析了61例患者,年龄从6个月至17岁。29例患者(47%)未接受任何形式的PSA。在接受PSA的儿童中,使用了以下方案:氯胺酮;咪达唑仑;氯胺酮+咪达唑仑;咪达唑仑+匹利卡明;丙泊酚;丙泊酚+咪达唑仑;全身麻醉。

结论

在进行LP测量脑脊液初压的儿童中,疼痛和应激管理往往不足。疼痛、应激以及PSA方案的变异性可能是压力测量的混杂因素。为了防止PTC的误诊并在不同中心获得可比结果,对于进行LP测量脑脊液初压的儿童的PSA需要达成普遍共识。

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