小儿骨盆三联截骨术术后镇痛的效果观察与护理

Effect of postoperative analgesia in children with pelvic triple osteotomy and nursing

目的观察静脉吗啡和硬膜外吗啡复合丁哌卡因用于小儿骨盆三联截骨术术后镇痛的效果和安全性，并探讨其镇痛护理方法。方法选择2011年1月至2012年3月在上海市第六人民医院行择期骨盆三联截骨术的患儿48例，按投币法随机分为静脉吗啡组（A组）、硬膜外吗啡复合丁哌卡因镇痛组（B组）和对照组（C组）。采用改良客观疼痛评分（OPS）分别记录3组患者术后2，4，8，12，24，48h的镇痛效果，同时记录不良反应的发生率。结果术后4，8，12，24，48hA组与B组镇痛效果比较，差异均无统计学意义（χ2分别为1．000，0．356，0．356，1．000，1．000；P〉0．05），但均明显优于C组（P〈0．05）。A组不良反应发生率为81．2％，B组为12．5％，C组为50．0％，3组比较，差异有统计学意义（Z=14．877，P〈0．01）；A组不良反应发生率高于B组及C组，差异有统计学意义（χ2分别为14．710，5．073；P〈0．05）。结论硬膜外吗啡复合丁哌卡因用于小儿骨盆三联截骨术术后镇痛效果较为明显，且不良反应发生率更低。麻醉护士为患儿术后提供安全、有效的镇痛护理，促进术后恢复，提高患儿及其家属的满意度。

Objective To observe the effect and safety of intravenous morphine and epidural combination of morphine and bupivacaine in children after pelvic triple osteotomy and discuss postoperative nursing methods. Methods 48 children who had received pelvic triple osteotomy from January 2011 to March 2012 in Shanghai 6th Hospital were chosen and randomly divided into the intravenous morphine group （ Group A）, epidural combination of morphine and bupivacaine group （ Group B） and the control group （ Group C ）. OPS was used to record analgesic effect 2, 4, 8, 12, 24 and 48 hours after operation as well as the incidence rate of adverse events. Results There were no statistically significant differences in analgesic effect 4, 8, 12, 24 and 48 hours after operation between Group A and Group B （χ2 = 1. 000,0. 356,0. 356,1. 000,1. 000, respectively;P 〉0. 05）. And the effect in both groups were obviously better in that in Group C （P 〈0. 05）. The incidence rate of adverse events was 81.2% in Group A, 12.5% in Group B, 50.5% in Group C, and the differences were statistically significant （z = 14. 877, P 〈 0. 01 ）. The rate in Group A was higher than that in both Group B and Group C, and the differences were statistically significant （χ2 = 14. 710,5. 073, respectively; P 〈 0. 05 ）. Conclusions Epidural combination of morphine and bupivacaine has better analgesic effect on children after pelvic triple osteotomy and lower incidence rate of adverse events. Nurses should provide safe and effective analgesic nursing to promote their recovery and improve the satisfaction rate of children and their parents.