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目的:吗啡在小儿硬膜外术后自控镇痛(PCEA)和吗啡静脉术后自控镇痛(PCIA)在小儿中的应用,寻找更好的术后自控镇痛用药方式。方法:选择7~14岁,将施行中腹部以下手术,ASAⅠ~Ⅱ级患儿48例,所有患儿采用硬膜外阻滞加异丙酚静脉注射辅助麻醉,在手术开始时即安装FORNIA一次性使用自控镇痛泵给予自控镇痛(PCA),PCA配方:吗啡加生理盐水100ml混合液,持续注入量2ml/h,单次剂量0.5ml,锁定时间15min。根据给药途径随机分成两组,A组:PCEA吗啡4μg/kg.h加生理盐水100ml。B组PCIA吗啡25μg/kg.h加生理盐水100ml。比较患儿术后4,8,12,24h的镇痛效果(VAS评分),术后24h内PCA的按压次数,恶心呕吐,皮肤瘙痒,低血压,心动过缓,镇静,嗜睡等并发症的发生情况。结果:两组患儿术后4,8,12,24h的VAS评分和术后24h内PCA的按压次数相仿(P>0.05)。但B组恶心呕吐,皮肤瘙痒,低血压,心动过缓,镇静,嗜睡等不良反应的发生率明显高于A组(P<0.05)。结论:小儿应用吗啡PCEA比PCIA更安全,副作用更少,其并发症的发生率更低。
OBJECTIVE: To investigate the application of morphine in pediatric postoperative epidural analgesia (PCEA) and morphine intravenous postoperative analgesia (PCIA) in pediatric patients in order to find a better postoperative controlled analgesia. Methods: A total of 48 ASA Ⅰ ~ Ⅱ children undergoing mid-abdomen surgery were selected from 7 to 14 years old. All children received anesthesia with epidural block plus propofol intravenous injection, and once at the beginning of the operation, FORNIA was installed The use of controlled analgesia pump to give controlled analgesia (PCA), PCA formula: morphine plus saline 100ml mixture, continuous infusion of 2ml / h, a single dose of 0.5ml, locking time 15min. According to the route of administration were randomly divided into two groups, A group: PCEA morphine 4μg / kg.h plus saline 100ml. Group B PCIA morphine 25μg / kg.h plus saline 100ml. The analgesic effect (VAS score) at 4, 8, 12 and 24 hours after operation was compared between the two groups. The number of PCA compression, nausea and vomiting, pruritus, hypotension, bradycardia, sedation and drowsiness What happened? Results: The VAS scores at 4, 8, 12 and 24 hours after operation in both groups were similar to those of PCA within 24 hours after operation (P> 0.05). However, the incidence of nausea and vomiting, pruritus, hypotension, bradycardia, sedation and drowsiness in group B was significantly higher than that in group A (P <0.05). CONCLUSIONS: Morphine PCEA in children is safer and less side-effects than PCIA, with a lower incidence of complications.