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題名 | 小兒術後疼痛控制新方法:比較病人靜脈自控式止痛與連續靜脈灌注止痛 |
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作者姓名(中文) | 林國強; 蔡勝國; 許淑霞; 吳國安; 褚錦承; 王漢志; 何照明; 李德譽; 錢大維; 魏拙夫; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 26:6 民82.11-12 |
頁次 | 頁2118-2125 |
分類號 | 417.662 |
關鍵詞 | 小兒; 術後止痛; 病人靜脈自控式止痛; 連續靜脈灌注止痛; |
語文 | 中文(Chinese) |
中文摘要 | 本研究的目的在於探討病人靜脈自控式止痛與連續靜脈注射止痛於小兒術後止痛之效果與安全性。挑選30位年齡自3歲至15歲ASA I-II級接受胸部、上、下腹部手術之小兒病患,自麻醉當中完全恢復後,並感覺嚴重疼痛時,隨機分組。第一組病人透過ABBOTT PROVIDER 5500病人自控式止痛機器接受靜脈嗎啡注射,單劑量(bolus dose)為0.015 mg/kg (1 mℓ)嗎啡,間隔時間(lock out time)設定十分鐘。另一組病人接受連續靜脈嗎啡注射。開始之劑量為0.01 mg/kg/hr,其注射速度根據病人對疼痛的反應(疼痛級數大於3)經由麻醉醫師調節,每30分鐘容許嗎啡劑量增加或減少2.5 μg/kg/hr。整個研究過程中,在兩組病人的疼痛等級相似情況下,病人自控式止痛組所需之嗎啡劑量第一天為0.16±0.09 mg/kg,第二天為0.046±0.03 mg/kg;連續靜注止痛組則第一天為0.25±0.05 mg/kg,第二天為0.21±0.08 mg/kg。連續靜注組之病人產生嘔吐(20%),發癢(20%)及頭痛(13%)之發生率則較病患自控式止痛組為高,但無統計上的意義。使用ABBOTT PROVIDER 5500 PCA Machine配合morphine單劑量0.015 mg/kg,間隔時問10分鐘及continuous infusion analgesia 0.01 mg/kg/hr,均能提供安全而有效的小兒病患術後止痛方法。在相同之疼痛等級下,病人自控式止痛組之病人所需嗎啡之用量較連續靜注止痛組為少(p<0.05)。 |
英文摘要 | Patient-controlled analgesia ( PCA ) and continuous infusion analgesia ( CIA ) are widely used for postoperative pain relief in adults. However those procedures are infrequently performed in children, and dose requirement has been reported to be unpredictable. The present study was undertaken to evaluate the efficacy and safety of PCA and CIA for postoperative pain relief in children. Thirty children, ASA class I-II patients, ages ranging from 3 to 15 years, who were scheduled for elective surgery under N2O, O2 and Halothane anesthesia, were enrolled in this study. All patients were administered succinylcholine 1.5 mg/kg iv to facilitate tracheal intubation; atracurium was given to provide muscular relaxation. During surgery, Electrocardiogram (EKG), blood pressure(NIBP),blood oxygen saturation and core temperature were monitored. Informed parental consents were obtained. In the postoperative period, when patients had fully recovered from anesthesia and complained of severe pain, they were divided into Groups I and II in a randomized fasion. Patients in Group I (n=15) received PCA iv morphine through an ABBOTT PROVIDER 5500 PCA Machine. A bolus dose of 0.015 mg/kg (1 ml) morphine and a lockout interval of 10 minutes were the initial setting. Neither back-ground infusion nor loading dose was used. Patients in Group II (n=15) received continuous iv morphine infusion. The initial dose was set at 0.01 mg/kg/hr. The rate was then adjusted by the anesthetist according to the pain response ( pain scale > 3 ) of the patient. A dose up and down of 2.5 μg/kg/hr was allowed every 30 minutes. Nurses recorded respiratory rate, pulse rate. O2 saturation, pain scale and sedation score every hour. Patients were evaluated for any complication or side effects associated with narcotic administration. There parameters included respiratory depression, nausea, vomiting, itching and urinary retention. Demographics, pain scale and sedation score were similar in both groups. PCA patients required less dose than CIA patients at equal pain scale. The total dose of morphine was respectively 0.206±0.12 mg/kg in PCA group and 0.46±0.06 mg/kg in CIA group throughout the total study period. CIA patients had more incidence of vomiting (20%), nausea (13%), pruritis (20%) and headache (13%) than PCA patients. In conclusion, PCA iv morphine is safe and beneficial in providing small requirement dose in pediatric patients. |
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