中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2012年
5期
350-355
,共6页
吗啡%婴儿,新生%通气,机械%疼痛
嗎啡%嬰兒,新生%通氣,機械%疼痛
마배%영인,신생%통기,궤계%동통
Morphine%Infant,newborn%Ventilators,mechanical%Pain
目的 评价持续静脉滴注吗啡对机械通气新生儿的镇痛作用以及对近期预后的影响.方法 选择2010年8月至2011年4月入住南京医科大学附属南京儿童医院新生儿重症监护室(neonatal intensive care unit,NICU)需要机械通气的早产儿(≥32周)和足月儿共46例.事先由非本课题组人员准备15组不透明信封,在每组4个信封内分别装入写有“A”,“A”,“B”,“B”各1张纸条.患儿纳入研究后由参与本课题研究但不参与疼痛评估及相关数据记录的1名人员随机抽取1组信封内的1个信封,信封内纸条写“A”入试验组,写“B”则入对照组.下一次分配患儿入组时在该组剩下的3个信封中随机抽取1个信封,按照上述原则入组,直至该组4个信封抽取完再抽取下1组信封,依此类推.试验组共22例,机械通气后静脉滴注吗啡首剂100μg/kg( ＞1 h),随后10μg/(kg·h)持续滴注,达撤药标准后撤药,平均滴注时间为(70.05 ±29.05)h；对照组24例,以相同滴注速度静脉滴注5％葡萄糖水.(1)比较两组用药前、用药后(30 min,2、6、12、24、48 h)机械通气参数[设置呼吸频率(respiratory rate,R)、总频率(frequence,f)、吸入峰压(peak inspiratory pressure,PIP)、呼气末正压(positive end expiratory pressure,PEEP)、吸入氧浓度(fraction of inspired oxygen,FiO2)]和患儿平均血压、心率；(2)采用N-PASS与COMFORT双疼痛评分量表评估两组患儿各时段的疼痛行为反应评分；(3)比较两组患儿机械通气时间,撤药至撤机时间,总氧疗时间,副反应发生情况及临床合并症[肺出血、气漏、动脉导管未闭(patent ductus arteriosus,PDA)、坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、脑室内出血(intraventricular hemorrhage,IVH)等]的发生率.结果 (1)试验组各时段呼吸机参数、平均血压与对照组无统计学差异,试验组心率在24、48 h低于对照组(t=-2.152和-2.513,P＜0.05)；(2)试验组在给药2h后各时段的N-PASS评分及COMFORT评分均低于对照组(P＜0.05),特别是在给药12后h降低更明显(P＜0.01)；(3)两组的机械通气持续时间、撤药至撤机时间、总氧疗时间无统计学差异；两组药物副反应发生率、脑室内出血、脑白质损伤发生率及临床合并症的发生率均无统计学差异.结论 持续静脉滴注吗啡能较好减轻机械通气新生儿疼痛,减少应激反应,促进人机协调,对近期预后无明显影响.
目的 評價持續靜脈滴註嗎啡對機械通氣新生兒的鎮痛作用以及對近期預後的影響.方法 選擇2010年8月至2011年4月入住南京醫科大學附屬南京兒童醫院新生兒重癥鑑護室(neonatal intensive care unit,NICU)需要機械通氣的早產兒(≥32週)和足月兒共46例.事先由非本課題組人員準備15組不透明信封,在每組4箇信封內分彆裝入寫有“A”,“A”,“B”,“B”各1張紙條.患兒納入研究後由參與本課題研究但不參與疼痛評估及相關數據記錄的1名人員隨機抽取1組信封內的1箇信封,信封內紙條寫“A”入試驗組,寫“B”則入對照組.下一次分配患兒入組時在該組剩下的3箇信封中隨機抽取1箇信封,按照上述原則入組,直至該組4箇信封抽取完再抽取下1組信封,依此類推.試驗組共22例,機械通氣後靜脈滴註嗎啡首劑100μg/kg( ＞1 h),隨後10μg/(kg·h)持續滴註,達撤藥標準後撤藥,平均滴註時間為(70.05 ±29.05)h；對照組24例,以相同滴註速度靜脈滴註5％葡萄糖水.(1)比較兩組用藥前、用藥後(30 min,2、6、12、24、48 h)機械通氣參數[設置呼吸頻率(respiratory rate,R)、總頻率(frequence,f)、吸入峰壓(peak inspiratory pressure,PIP)、呼氣末正壓(positive end expiratory pressure,PEEP)、吸入氧濃度(fraction of inspired oxygen,FiO2)]和患兒平均血壓、心率；(2)採用N-PASS與COMFORT雙疼痛評分量錶評估兩組患兒各時段的疼痛行為反應評分；(3)比較兩組患兒機械通氣時間,撤藥至撤機時間,總氧療時間,副反應髮生情況及臨床閤併癥[肺齣血、氣漏、動脈導管未閉(patent ductus arteriosus,PDA)、壞死性小腸結腸炎(necrotizing enterocolitis,NEC)、腦室內齣血(intraventricular hemorrhage,IVH)等]的髮生率.結果 (1)試驗組各時段呼吸機參數、平均血壓與對照組無統計學差異,試驗組心率在24、48 h低于對照組(t=-2.152和-2.513,P＜0.05)；(2)試驗組在給藥2h後各時段的N-PASS評分及COMFORT評分均低于對照組(P＜0.05),特彆是在給藥12後h降低更明顯(P＜0.01)；(3)兩組的機械通氣持續時間、撤藥至撤機時間、總氧療時間無統計學差異；兩組藥物副反應髮生率、腦室內齣血、腦白質損傷髮生率及臨床閤併癥的髮生率均無統計學差異.結論 持續靜脈滴註嗎啡能較好減輕機械通氣新生兒疼痛,減少應激反應,促進人機協調,對近期預後無明顯影響.
목적 평개지속정맥적주마배대궤계통기신생인적진통작용이급대근기예후적영향.방법 선택2010년8월지2011년4월입주남경의과대학부속남경인동의원신생인중증감호실(neonatal intensive care unit,NICU)수요궤계통기적조산인(≥32주)화족월인공46례.사선유비본과제조인원준비15조불투명신봉,재매조4개신봉내분별장입사유“A”,“A”,“B”,“B”각1장지조.환인납입연구후유삼여본과제연구단불삼여동통평고급상관수거기록적1명인원수궤추취1조신봉내적1개신봉,신봉내지조사“A”입시험조,사“B”칙입대조조.하일차분배환인입조시재해조잉하적3개신봉중수궤추취1개신봉,안조상술원칙입조,직지해조4개신봉추취완재추취하1조신봉,의차유추.시험조공22례,궤계통기후정맥적주마배수제100μg/kg( ＞1 h),수후10μg/(kg·h)지속적주,체철약표준후철약,평균적주시간위(70.05 ±29.05)h；대조조24례,이상동적주속도정맥적주5％포도당수.(1)비교량조용약전、용약후(30 min,2、6、12、24、48 h)궤계통기삼수[설치호흡빈솔(respiratory rate,R)、총빈솔(frequence,f)、흡입봉압(peak inspiratory pressure,PIP)、호기말정압(positive end expiratory pressure,PEEP)、흡입양농도(fraction of inspired oxygen,FiO2)]화환인평균혈압、심솔；(2)채용N-PASS여COMFORT쌍동통평분량표평고량조환인각시단적동통행위반응평분；(3)비교량조환인궤계통기시간,철약지철궤시간,총양료시간,부반응발생정황급림상합병증[폐출혈、기루、동맥도관미폐(patent ductus arteriosus,PDA)、배사성소장결장염(necrotizing enterocolitis,NEC)、뇌실내출혈(intraventricular hemorrhage,IVH)등]적발생솔.결과 (1)시험조각시단호흡궤삼수、평균혈압여대조조무통계학차이,시험조심솔재24、48 h저우대조조(t=-2.152화-2.513,P＜0.05)；(2)시험조재급약2h후각시단적N-PASS평분급COMFORT평분균저우대조조(P＜0.05),특별시재급약12후h강저경명현(P＜0.01)；(3)량조적궤계통기지속시간、철약지철궤시간、총양료시간무통계학차이；량조약물부반응발생솔、뇌실내출혈、뇌백질손상발생솔급림상합병증적발생솔균무통계학차이.결론 지속정맥적주마배능교호감경궤계통기신생인동통,감소응격반응,촉진인궤협조,대근기예후무명현영향.
Objective To evaluate the effects of morphine infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in ventilated neonates.Methods A randomized,double-blind clinical trial was conducted between August 2010 and April 2011 at the neonatal intensive care unit of Nanjing Children's Hospital Affiliated to Nanjing Medical University.A total of 46 ventilated preterm infants( ≥32 weeks)and term infants were divided into 2 groups at random.Twenty-two infants in test group received a loading dose ( 100 μg/kg) of morphine ( ＞ 1 h) followed by a continuous infusion [ 10 μg/ ( kg · h ) ]for (70.05 ±29.05) h,and 24 infants in control group received 5％ glucose with the same infusion rate.( 1 ) The ventilatory parameters [respiratory rate (R),frequence (f),peak inspiratory pressure (PIP),positive end expiratory pressure (PEEP),fraction of inspired oxygen (FiO2 )],mean blood pressure (MBP) and heart rate (HR) before treatment,at 30 min,2 h,6 h,12 h,24 h,48 h after treatment between two groups were compared.( 2 ) Pain was measured by two assessment tools [ neonatal pain,agitation and sedation scale (N-PASS) and COMFORT scale ]at the same periods. (3) The ventilation duration,the time from withdrawal to extubation,the total oxygen-inhaled time,the side effects and the clinical outcomes [ e.g.,pulmonary hemorrhage,air leak,patent ductus arteriosus (PDA),necrotizing enterocolitis ( NEC),intraventricular hemorrhage ( IV H ) ]between two groups were compared.Results ( 1 ) There were no significant differences in the different ventilatory parameters before and after treatment between two groups at different periods ( P ＞ 0.05 ).There was no significant difference in the average blood pressure of two groups at different periods,but the heart rate reduced at 24-48 h after treatment in test group with significant difference as compared to control group (t =-2.152 and -2.513,P ＜0.05 ).(2) The N-PASS score and COMFORT score in test group were lower than that in control group at different time points 2 h after treatment ( P ＜ 0.05 ),especially 12 h after treatment ( P ＜ 0.01 ).( 3 )There were no significant differences in the ventilation duration,the time from withdrawal to extubation and the total oxygen time between two groups,and also in side effects,the incidence of IVH,white matter damage and the clinical outcomes. Conclusion Continuous infusion of morphine could relieve pain in ventilated neonates,reduce the stress response and promote the human-machine coordination,but the medication did not show any effects on neurobehavioral development and short term outcome.
