父母控制的静脉镇痛应用于婴儿术后镇痛的效果及其评估  

Assessment of postoperative parent-controlled intravenous analgesia in infants

作　　者：周志坚[1] 余新[2] 王炫[1] 张学锋[1] 郑珊[3] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海201102 [2]福建省福清市医院麻醉科 [3]复旦大学附属儿科医院外科,上海201102

出　　处：《上海医学》2011年第10期739-741,共3页Shanghai Medical Journal

摘　　要：目的以面部表情评分（FPRS）和行为学评分（FLACC评分，即face、legs、activity、crying、consolability）评价由父母控制的患者自控镇痛（PCA）应用于婴儿术后静脉镇痛的效果。方法行择期手术的婴儿83例，美国麻醉医师学会（ASA）分级Ⅰ～Ⅱ级，根据年龄分为A组（1～6个月，43例）和B组（6～24个月，40例）。镇痛药物为吗啡，负荷量为20～40μg／kg，持续静脉输注剂量为8μg·kg-1·h-1,锁定时间10min，PCA剂量为8μg／kg。观察患儿在术后24和48h的FPRS、FLACC评分和PCA剂量，并于镇痛治疗结束时由父母评价镇痛效果的满意度，记录不良反应情况。结果A、B组婴儿在术后24h的FPRS中位数（第25百分位数，第75百分位数）分别为4．0（2．0，6．0）、4．0（2．0，4．0）分，术后48h分别为2．0（0，2．0）、1．0（O，2．0）分，两组间差异均无统计学意义（P值均〉O．05）。A、B组婴儿在术后24h的FLACC评分中位数（第25百分位数，第75百分位数）分别为5．0（2．0，6．0）、2．0（1．25，4．0）分，A组显著高于B组（P〈0．05）；术后48h的FLACC评分中位数（第25百分位数，第75百分位数）分别为4．O（2．0，6．O）、2．0（O，2．O）分，差异无统计学意义（P〉0．05）。婴儿在术后24和48h的FPRS与FLACC评分（r=0．772、0．689）、父母满意度与FPRS（r=0．406、0．395）以及父母满意度与FLACC评分（r=0．393、0．421）均呈正相关（P值均〈0．01）。结论婴儿尤其是年龄〈6个月的婴儿，应用父母控制的PCA后，术后第1天内仍处于轻至中度疼痛状态。FPRS与FLACC评分在这类患儿的疼痛评估中的相关性好，而父母满意度则不能代替疼痛学评估。Objective To evaluate the effect of postoperative parent-controlled intravenous analgesia in infants with face pain rating scale （FPRS） and FLACC （face, legs, activity, crying, consolability） scale. Methods Eighty-three infants, aged 1 -24 months, American Society of Anesthesiologists （ASA） graded I - ][ and scheduled for elective surgery, were enrolled in this study. They were divided into group A （ 1 - 6 months, 43 cases） and group B （6 - 24 months, 40 cases） according to their age. After a loading dose of 20 - 40 μg/kg, morphine was infused intravenously by a patient-controlled analgesia （PCA） system （background dose 8 μg kg-1 h-1 and bolus dose 8 μg/kg with a lockout interval of 10 min） in a parent-controlled way. Scores of pain （FPRS and FLACC） and PCA dose were recorded 24 hours and 48 hours after surgery. And parental satisfaction （PS） and adverse reactions were accessed after the treatment. Results Postoperative （24 hours and 48 hours after surgery） median FPRS scores in group A and B were 4.0 （2.0, 6.0）, 4.0（2.0, 4.0） and 2.0 （0, 2.0）, 1.0 （0, 2.0）, respectively. There was no significant difference between the two groups （all P〉 0.05）. Despite the significant difference in median FLACC scores （5.0 [2.0, 6.0], 2.0 [1.25, 4.0], P〈O. 05） 24 hours after operation, there was no significant difference when another 24 hours passed （4.0 [2.0, 6.0], 2.0 [0, 2.0], P〉O. 05）. Spearman correlation coefficients were significant between FPRS, FLACC and PS （r =0.77224 hand r=0.689 48 h, FPRS vs. FLCC; r=0.406 24 h and r=0.395 48 h, FPRS vs. PS; r= 0.393 24 h and r=0.421 48 h,FLACC vs. PS; P〈0.01） postoperatively. Conclusion With a PCA system in a parent-controlled way, post operative pain is slight to moderate in infants one day after operation, especially in those younger than 6 months. There is a good correlation between FPRS and FLACC when they are used to evaluate the effect of analgesia in these patients. However, the role of pain

关 键 词：患者自控镇痛 婴儿 吗啡 疼痛评估 

分 类 号：R726.1[医药卫生—儿科]