骨科下肢手术患儿术后父母控制静脉镇痛的效应

Parent-controlled analgesia for postoperative management in children

目的评价骨科下肢手术患儿术后父母控制静脉镇痛的效应。方法择期行骨科下肢矫形手术患儿507例，ASAⅠ或Ⅱ级，年龄10月～8岁，8．5～34．0kg。按年龄分为2组：〈6岁的患儿采用父母控制静脉镇痛组（n=308）；≥6岁的患儿采用自控静脉镇痛组（n=199）。气管插管或喉罩全麻复合0．25％布比卡因骶管阻滞下进行手术，术后给予吗啡镇痛，背景输注速率15ug^-1·kg^-1·h，PCA量15ug／kg，锁定时间10min。于术后4、24、48h时，采用Wong—Baker面部表情评分法或改良面部表情评分法评价疼痛程度；采用Ramsay评分评价镇静程度。于术后24、48h时记录PCA次数和吗啡剂量；记录术后48h内不良反应的发生情况。结果两组术后镇痛效果、镇静水平、PCA次数、吗啡剂量和不良反应发生率差异无统计学意义（P〉0．05）。结论父母控制静脉镇痛可安全、有效地用于骨科下肢手术患儿术后镇痛。

Objective To evaluate the efficacy and safety of parent-controlled analgesia for postoperative pain management in pediatric patients. Methods Five hundred and seven ASA Ⅰ or Ⅱ pediatric patients aged 10 months to 8 yr, weighting 8.5-34.0 kg, undergoing lower limb operations performed under general anesthesia combined with caudal block were assigned into 2 age groups： group PCIA-P （ 〈 6 yr, n = 308） and group PCIA （ ≥ 6 yr, n = 199） . Anesthesia was induced with intravenous midazolam 1 mg/kg, ketamine 2 mg/kg and propofol 2 mg/kg. Laryngeal mask airway （LMA） was introduced or the patients were intubated. After induction, caudal block was performed with 0.25 % bupivacaine 2.5 mg/kg with adrenaline 1：400 000. The patients received PCA with morphine after operation. The PCA pump was controlled by parent in group PCIA-P and by patient in group PCIA. The PCA regimen included a background infusion of morphine at a rate of 15 ug· ^-1kg^-1· -h, a bolus of 15 ug/kg and a 10 min lockout interval. The vital signs, pain score, sedation score, number of attempts, morphine dosage and side effects were recorded. Results The two groups were comparable with respect to the rate of satisfactory analgesia, level of sedation, number of attempts, morphine dosage and side effects. The rates of satisfactory analgesia were 72.7% and 80.2% in group PCIA-P vs 77.9% and 78.9% in group PCIA at 24 and 48 h after operation respectively （ P 〉 0.05） . Conclusion Parent-controlled analgesia could be used safely and effectively in children after orthopedic surgery.