氢吗啡酮应用于儿童先天性心脏病术后镇痛疗效与安全性研究  

Efficacy and safety of hydromorphone for postoperative analgesia in children

作　　者：龚雨姗 皮丹丹[1] 刘成军[1] 李静[1] 符跃强[1] 许峰[1] Gong Yushan;Pi Dandan;Liu Chengjun;Li Jing;Fu Yueqiang;Xu Feng(Pediatric Intensive Care Unit,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,International Science and Technology Cooperation Base of Child Development and Critical Disorders,Children′s Hospital of Chongqing Medical University,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,400014

出　　处：《中国小儿急救医学》2022年第11期880-885,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨氢吗啡酮用于儿童先天性心脏病术后镇痛疗效与安全性,为其用于儿童术后镇痛提供合适的用药参考剂量。方法采用前瞻性研究,选择2019年11月到2021年11月于重庆医科大学附属儿童医院行先天性心脏病手术(ASAⅡ~Ⅳ级)且术后入住PICU的157例患儿,随机单盲分为5组,氢吗啡酮低剂量组(H1组,30例):氢吗啡酮剂量≥2且<3μg/(kg·h);氢吗啡酮中剂量组(H2组,30例):氢吗啡酮剂量≥3且<4μg/(kg·h);氢吗啡酮高剂量组(H3组,31例):氢吗啡酮剂量≥4且≤5μg/(kg·h);舒芬太尼组(S组,36例):舒芬太尼剂量为0.08μg/(kg·h);吗啡组(M组,30例),吗啡剂量为20μg/(kg·h)。5组患儿同时静脉输注咪达唑仑2μg/(kg·min)作为镇静治疗。于术后1 h、4 h、8 h、12 h、24 h进行疼痛评分和镇静评分。同时监测心率、平均动脉压、血糖、乳酸、血清皮质醇水平,并对不良反应发生情况、临时需追加镇痛镇静药物的患儿例数及次数、机械通气时间进行比较。结果(1)5组患儿年龄、体重、体外循环时间、小儿危重病例评分、ASA评分组间差异均无统计学意义(P均>0.05)。(2)术后各组患儿呼吸、心率、血糖、乳酸及血清皮质醇水平无明显差异(P均>0.05)。各组患儿术前平均动脉压无明显差异,术后各组平均动脉压在4 h、8 h差异有统计学意义(P<0.05)。(3)H1组、H2组、H3组在术后1 h、4 h、12 h、24 h镇痛满意度显著高于M组(P<0.05),H1组、H2组、H3组间在各时间点镇痛满意度无明显差异。(4)H1组、H2组、H3组在术后4 h、24 h镇静满意度显著高于M组(P<0.05)。H1组、H2组、H3组间在各时间点镇静满意度无明显差异。(5)H1组、H2组、H3组与S组在术后镇痛满意度和镇静满意度均无明显差异。(6)H1组[1(0,2)次]、H2组[1(0,2)次]、H3组[1(0,2)次]组患儿24 h内追加镇痛镇静药物次数少于M组[2(2,3)次],差异均有统计学意义(P均<0.05),且H1组、H2组、H3组追加镇痛�Objective To investigate the efficacy and safety of hydromorphone for postoperative analgesia in children with congenital heart disease,and provide a suitable reference dose for postoperative analgesia in children.Methods Using a prospective study,157 patients with congenital heart disease(ASAⅡ-Ⅳ)admitted to pediatric intensive care unit at Children′s Hospital of Chongqing Medical University from November 2019 to November 2021 were randomly divided into five groups.Low-dose hydromorphone group(H1 group,30 cases):hydromorphone dose≥2 and<3μg/(kg·h),hydromorphone medium-dose group(H2 group,30 cases):hydromorphone dose≥3 and<4μg/(kg·h),high-dose hydromorphone group(H3 group,31 cases):hydromorphone dose≥4 and≤5μg/(kg·h),sufentanil group(S group,36 cases):the dose of sufentanil was 0.08μg/(kg·h),morphine group(M group,30 cases):the dose of morphine was 20μg/(kg·h).The five groups of children received midazolam 2μg/(kg·min)intravenously at the same time as sedative therapy.Pain score and sedation score were scored at 1 h,4 h,8 h,12 h,and 24 h after operation.Heart rate,mean arterial pressure,blood glucose,lactate,and serum cortisol levels were also monitored and detected,and the occurrence of adverse reactions,the number of cases requiring additional analgesic and sedative drugs,as well as the duration of mechanical ventilation were compared.Results(1)There were no significant differences regarding the age,body weight,cardiopulmonary bypass time,pediatric critical illness score and ASA score among five groups(all P>0.05).(2)There was no significant difference in the levels of respiration,heart rate,blood sugar,lactate and serum cortisol among five groups after operation.There was no significant difference in preoperative mean arterial pressure among the groups,but there was significant difference in the postoperative mean arterial pressure among the groups at 4 h and 8 h(P<0.05).(3)The analgesic satisfaction of H1 group,H2 group and H3 group at 1 h,4 h,12 h and 24 h after operation was signifi

关 键 词：先天性心脏病 镇静 镇痛 氢吗啡酮 舒芬太尼 吗啡 

分 类 号：R726.5[医药卫生—儿科]