吗啡不同给药途径在小儿术后自控镇痛中的应用  

The Different Way of Morphine PCA in Children

作　　者：李莉[1] 刘怀萍[1] 陈燕珠[1] 

机构地区：[1]汕头大学医学院第二附属医院,广东汕头515041

出　　处：《河北医学》2008年第3期301-303,共3页Hebei Medicine

摘　　要：目的：吗啡在小儿硬膜外术后自控镇痛（PCEA）和吗啡静脉术后自控镇痛（PCIA）在小儿中的应用，寻找更好的术后自控镇痛用药方式。方法：选择7～14岁，将施行中腹部以下手术，ASAI～Ⅱ级患儿48例，所有患儿采用硬膜外阻滞加异丙酚静脉注射辅助麻醉，在手术开始时即安装FORNIA一次性使用自控镇痛泵给予自控镇痛（PCA），PCA配方：吗啡加生理盐水100ml混合液，持续注入量2ml／h，单次荆量0．5ml，锁定时间15min。根据给药途径随机分成两组，A组：PCEA吗啡4μg／kg·h加生理盐水100ml。B组PCIA吗啡25μg／kg·h加生理盐水100ml。比较患儿术后4，8，12，24h的镇痛效果（VAS评分），术后24h内PCA的按压次数，恶心呕吐，皮肤瘙痒，低血压，心动过缓，镇静，嗜睡等并发症的发生情况。结果：两组患儿术后4，8，12，24h的VAS评分和术后24h内PCA的按压次数相仿（P〉0．05）。但B组恶心呕吐，皮肤瘙痒，低血压，心动过缓，镇静，嗜睡等不良反应的发生率明显高于A组（P〈0．05）。结论：小儿应用吗啡PCEA比PCIA更安全，副作用更少，其并发症的发生率更低。Objective： To compare the morphine in post - operative patient controlled epidural analgesia （ PCEA ） and post - operative patient controlled iv analgesia （ PCIA ） in children, to have satisfacting analgesic way with less side effects. Method- 48 children 7 ～ 14 - year - old ASA Ⅰ ～ Ⅱ undergoing surgical operation below umbical were chosen. All the children were performed epidural anesthesia combined with propofol intravenous anaesthesia. In the beginning of operation, we arranged PCA, the drogs were doluted 100ml and infused by a pumb in a rate of 2ml/h, with a patient-controlled blous of 0.5ml, lockout 15 min, accord- ing to the way of morphine, the 48 children were randomly divided into 2 groups：Group A： 41μg/kg · h PCEA. Group B ： 25 μg/kg · h PCIA. The post - operative 4,8,12,24h visual analog scale （VAS）, post -operative 24 PCA and incidence of side effects such as nausia, vomiting, itching, hypotension, bradyrhythmia, were recorded. Result：The post - operative 4h, 8h, 12h,24h VAS,24h PCA in two groups were similar, （ P〉 0.05 ）, the accidence of nausia, vomiting, itching, hypotension , bradyrhythm in group B was significantly more than that in group A （ P 〈 0.05 ）. Conclusion： Small dose of morphine 41.Lg/kg· h PCEA in children has the better analgesia effects,less complication than that of PCIA.

关 键 词：小儿 吗啡 硬膜外术后自控镇痛 静脉术后自控镇痛 

分 类 号：R726.1[医药卫生—儿科]