吗啡与氢吗啡酮在小儿静脉自控镇痛中的应用效果比较

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

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（P〈0.05）。M组皮肤瘙痒发生率（15%）显著高于H组（0%）（P〈0.05）,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。

Objective： To compare the analgesic effect and side-effect of morphine and hydromorphone in pediatric patient con- trolled 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. Group M （morphine 15 μg/kg/h basal infusion and PCA doses of 15 μg/k）, H （hydromorphone 3μg/kg/h basal infusion and PCA doses of 3 μg/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 group M compared with group H（P〈0.05） on Day 2 after treatment. Pruri- tus as a side-effect was more severe in group M （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.