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上海市卫生健康委员会
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父母控制的PCA用于小婴儿术后静脉镇痛
Effect of postoperative parents controlled intravenous analgesia in small infants

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DOI:
作者:
余新, 周志坚, 王炫, 张学锋
YU Xin, ZHOU Zhijian, WANG Xuan, ZHANG Xuefeng
作者单位:
余新 福建省福清市医院麻醉科 周志坚, 王炫, 张学锋 复旦大学附属儿科医院麻醉科
Department of anesthesiology, Children’s Hospital. Fudan University, Shangai 201102, China
关键词:
病人自控镇痛；婴儿；吗啡；疼痛评估
Patient controlled analgesia (PCA); infants; morphine; pain assessment
摘要:
目的 以面部表情评分(FPRS)和FLACC （Face, Legs, Activity, Crying, Consolability）量表，评价父母控制的镇痛(PCA, Parents Controlled Analgesia)应用于婴儿术后静脉镇痛的效果。方法 择期手术ASA1-2级婴儿83例，根据年龄分成A组 (1-6个月小婴儿) 43例和B组（6 -24个月）40例。镇痛药物为吗啡，负荷量20-40µg•kg-1，持续输注剂量8µg•kg-1•h-1，锁定时间10min，PCA剂量8µg•kg-1。观察术后24h和48h患儿的面部表情评分（FPRS）、FLACC量表评分和PCA剂量，并于镇痛治疗结束时由父母评价镇痛效果的满意度，记录不良反应。结果 两组婴儿术后24h和48hFPRS平均值相似(P>0.05)，分别为4.142.41、3.752.76和1.441.59、1.652.17；术后24h FLACC评分为4.142.63、2.752.43 (P<0.05)，术后48h分别为1.371.60、0.851.55 (P>0.05)。术后24hFPRS和FLACC之间相关系数r=0.772，父母满意度和FPRS相关系数r=0.406，父母满意度和FLACC相关系数r=0.393，P<0.01。术后48h FPRS和FLACC之间相关系数r=0.689，父母满意度和FPRS相关系数r=0.395，父母满意度和FLACC相关系数r=0.421，P<0.01。 结论 婴儿尤其是小于6个月者，采用父母控制的PCA后，术后第一天内仍处于轻至中度疼痛状态。面部表情评分(FPRS)和行为学评分(FLACC)在这类患儿的疼痛评估中相关性好，而父母满意度则不能代替疼痛学评估。
Objective To evaluate the effect of postoperative parents controlled intravenous analgesia in small infants with Face Pain Rating Scale (FPRS) and FLACC (Face, Legs, Activity, Crying, Consolability) Scale. Methods Eighty-three infants, aged 1-24 months, ASA graded 1-2 and scheduled for elective surgery, were enrolled in this study. They were divided into group A (1-6 months, 43 cases) and group B (6-24 months, 40 cases) according to age. After a loading dose of 20-40µg•kg-1, morphine was infused intravenously by a patient-controlled analgesia (PCA) system (background dose 8µg•kg-1•h-1 and bolus dose 8µg•kg-1 with a lockout interval of 10min) in a parents controlled way. Scores for pain and parents satisfaction (PS) were recorded 24 hours and 48 hours after surgery. Results Postoperative (24 hours and 48 hours after surgery) average FPRS scores in group A and B were 4.14±2.41, 3.75±2.76 and 1.44±1.59, 1.65±2.17 respectively with no significant difference between groups (P>0.05). Despite the significant difference of average FLACC scores (4.14±2.63, 2.75±2.43, P<0.05) 24 hours after operation, there was no significant difference between groups when another 24 hours passed (1.37±1.60, 0.85±1.55, P>0.05). Spearman correlation coefficients were significant between FPRS, FLACC and PS (r=0.772 24h and r=0.689 48h, FPRS vs FLCC; r=0.406 24h and r=0.395 48h, FPRS vs PS; r=0.393 24h and r=0.421 48h，FLACC vs PS; P<0.01) postoperatively . Conclusions Postoperative pain is slight to moderate in infants, especially in those younger than 6 months, using a PCA system in a parents controlled way. There is a good correlation between FPRS and FLACC when used to evaluate the effect of analgesia in these patients. However, the role of pain assessment can’t be replaced by parents satisfaction.

 

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