吗啡与氢吗啡酮在小儿静脉自控镇痛中的应用效果比较

目的:比较吗啡与氢吗啡酮在小儿静脉自控镇痛(PCIA)应用中的镇痛效果及副作用。方法:选取40名6~10岁择期行下肢骨科手术的患儿,术毕即予PCIA,随机分为两组:M组(吗啡背景剂量15μg/kg/h,PCA剂量15μg/kg)和H组(氢吗啡酮背景剂量3μg/kg/h,PCA剂量3μg/kg),每组20例。记录患儿PCIA后3、6、12、24和48h的FLACC疼痛评分、Ramsay镇静评分、PCA次数及不良反应的发生情况(恶心呕吐、皮肤瘙痒、尿潴留、过度镇静、呼吸抑制)。结果:两组患儿各时间点FLACC疼痛评分、Ramsay镇静评分比较均无统计学差异(P均0.05)。术后第二天,M组PCA次数少于H组,差异存在统计学意义(P0.05)。M组皮肤瘙痒发生率(15%)显著高于H组(0%)(P0.05),两组其余不良反应的发生情况比较均无统计学差异(P均0.05)。结论:氢吗啡酮与吗啡用于小儿术后PCIA的镇痛效果和安全性相当。

Comparison of the Effect of Morphine and Hydromorphone in the Patient Controlled Intravenous Analgesia of Pedia

Objective:To compare the analgesic effect and side-effect of morphine and hydromorphone in pediatric patient controlled intravenous analgesia (PCIA).Methods:Forty children, aged from 6 to 10 years, undergoing elective lower limb or hip operations were randomly divided into 2 groups to receive postoperative PCIA. GroupM (morphine 15 ug/kg/h basal infusion and PCA doses of 15 ug/k), H (hydromorphone 3ug/kg/h basal infusion and PCA doses of 3 ug/kg). The FLACC score, Ramsay sedation score, number of PCA boluses, and adverse reaction (such as nausea/vomiting, pruritus, retention of urine, over sedation and respiratory depression) were recorded at 3, 6, 12, 24, 48h after PICA.Results:The comfort b scores, ramsay sedation score were similar between 2 groups (P>0.05). There were significantly fewer demands of PCA boluses of the groupMcompared with group H(P<0.05) on Day 2 after treatment. Pruritus as a side-effect was more severe in groupM (P<0.05). There was no difference in the incidence rates of other opioid-related side effects between 2 groups.Conclusion:Both morphine and hydromorphone could provide appropriate analgesia and less side effects in pediatric PCIA.