氢吗啡酮用于患儿术后父母控制静脉镇痛的效果

Efficacy of hydromorphone for postoperative parent-controlled intravenous analgesia in pediatric pa-tients

目的评价氢吗啡酮用于患儿术后父母控制静脉镇痛的效果。方法择期行发育性髋关节脱位矫形术的患儿75例，性别不限，年龄2～5岁，ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组：舒芬太尼组（S组，n＝38）和氢吗啡酮组（H组，n＝37）。术后48 h内进行父母控制静脉镇痛，S组配方为舒芬太尼2 μg/kg，H组配方为氢吗啡酮200 μg/kg，均加生理盐水混合至100 ml，输注速度2 ml/h，单次剂量0.5 ml，锁定时间15 min。于拔除气管导管后0.5、1、4、8、12、24和48 h（T1～7）时记录Ramsay镇静评分，于术前1 h（T0）、T3、T6时测定血清P物质浓度，记录镇痛药物消耗总量、镇痛泵有效及无效按压次数、父母满意度评分和患儿药物相关不良反应发生情况。结果与S组比较，H组T1～3时镇静评分降低，无效按压次数增多（P〈0.05），药物消耗总量、有效按压次数、父母满意度评分、血清P物质浓度和药物相关不良反应发生率差异无统计学意义（P〉0.05）。结论氢吗啡酮可安全有效地用于小儿术后父母控制静脉镇痛。

ObjectiveTo evaluate the efficacy of hydromorphone for postoperative parent-controlled intravenous analgesia in pediatric patients. MethodsSeventy-five pediatric patients of both sexes, aged 2-5 yr, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for elective surgery for treatment of developmental displasia of the hip, were divided into 2 groups using a random number table： sufentanil group（group S, n=38）and hydromorphone group（group H, n=37）. Parent-controlled intravenous analgesia was carried out within 48 h after operation.Parent-controlled intravenous analgesia solution contained sufentanil 2 μg/kg（group S）or hydromorphone 200 μg/kg（group H）in 100 ml of normal saline.The analgesia pump was set up with a 0.5 ml bolus dose, a 15-min lockout interval and infusion at a rate of 0.5 ml/h.Ramsay sedation scores were recorded at 0.5, 1, 4, 8, 12, 24 and 48 h after extubation（T1-7）. At 1 h before operation（T0）, T3 and T6, blood samples were collected from the ulnar vein for determination of the concentration of substance P in serum.The total consumption of analgesics, the number of successfully delivered doses, the number of attempts and drug-related adverse reactions were recorded, and parents′ satisfaction was scored. ResultsCompared with group S, Ramsay sedation scores were significantly decreased at T1-3, the number of attempts was increased（P〈0.05）, and no significant change was found in the total consumption of analgesics, the number of successfully delivered doses, degree of parents′ satisfaction, serum concentration of substance P or incidence of drug-related adverse reactions in group H（P〉0.05）.ConclusionHydromorphone can be safely and effectively used for postoperative parent-controlled intravenous analgesia in pediatric patients.