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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 effects and side effects of morphine and hydromorphone in pediatric intravenous controlled analgesia (PCIA). Methods: Forty children aged 6 to 10 undergoing orthopedic surgery were randomly divided into two groups: M group (morphine background dose 15μg / kg / h, PCA dose 15μg / kg) and H Group (hydromorphone background dose 3μg / kg / h, PCA dose 3μg / kg), 20 cases in each group. FLACC pain score, Ramsay sedation score, PCA frequency and incidence of adverse reactions (nausea and vomiting, pruritus, urinary retention, hyper-sedation and respiratory depression) were recorded at 3, 6, 12, 24 and 48 h after PCIA in children. Results: There was no significant difference in FLACC pain score and Ramsay sedation score between the two groups (P> 0.05). On the second day after operation, the number of PCA in M group was less than that in H group, the difference was statistically significant (P <0.05). The incidence of skin pruritus in group M (15%) was significantly higher than that in group H (0%) (P <0.05). There was no significant difference in the incidence of other adverse reactions between the two groups (all P> 0.05). Conclusion: The analgesic effect and safety of hydromorphone and morphine for PCIA in children are similar.