国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
12期
1109-1112,1116
,共5页
疼痛,手术后%小儿,镇痛
疼痛,手術後%小兒,鎮痛
동통,수술후%소인,진통
Pain,postoperative%Children,analgesia
目的 了解当今国内小儿术后镇痛工作在儿童手术量较大的大型综合医院和儿童医院的应用情况,为小儿术后镇痛在国内推广应用提供参考. 方法 对全国预计小儿麻醉年手术量超过1000例的40家医院的麻醉科进行了问卷调查.31家医院完成调查,剔除年小儿手术量低于1 000例的4家,纳入27家医院进行分析.调查的内容包括医院镇痛管理相关政策和制度,小儿术后镇痛开展情况,如开展镇痛的年龄段、常用术后镇痛方式和药物、静脉镇痛泵配方、小儿术后镇痛存在的问题等. 结果 纳入分析的医院中88.9％开展了小儿术后镇痛工作,开展1岁～3岁幼儿术后镇痛的占81.5％,1个月～12个月婴儿术后镇痛的占55.6％,新生儿术后镇痛仅有25.9％.超过80％的医院建立了小儿术后镇痛相关培训,并有个性化镇痛方案和疗效评估,但只有59.3％的医院安排有专门的小儿术后镇痛人员,22.2％设置了术后镇痛服务小组.所有开展小儿术后镇痛的医院均使用静脉患者自控镇痛(patient controlled analgesia,PCA),只有25.9％医院开展硬膜外PCA方式镇痛.局麻药被广泛用于小儿术后镇痛,包括罗哌卡因、利多卡因和布比卡因,阿片类药物以舒芬太尼、芬太尼和曲马多为主,经常使用非甾体类抗炎药(non-steroid anti-inflammatory drugs,NSAIDs)的医院仅占29.6％,只有11.1％的医院经常使用对乙酰氨基酚. 结论 小儿术后镇痛工作在我国儿童手术较多的大型综合性医院和儿童医院已经普遍开展,但婴儿和新生儿的术后镇痛工作有待加强.有必要普及术后切口局麻药浸润,更多开展外周神经阻滞;普及副作用少又经济实用的对乙酰氨基酚类药物的使用,增加NSAIDs的用量,加强阿片类药物治疗安全的监控.
目的 瞭解噹今國內小兒術後鎮痛工作在兒童手術量較大的大型綜閤醫院和兒童醫院的應用情況,為小兒術後鎮痛在國內推廣應用提供參攷. 方法 對全國預計小兒痳醉年手術量超過1000例的40傢醫院的痳醉科進行瞭問捲調查.31傢醫院完成調查,剔除年小兒手術量低于1 000例的4傢,納入27傢醫院進行分析.調查的內容包括醫院鎮痛管理相關政策和製度,小兒術後鎮痛開展情況,如開展鎮痛的年齡段、常用術後鎮痛方式和藥物、靜脈鎮痛泵配方、小兒術後鎮痛存在的問題等. 結果 納入分析的醫院中88.9％開展瞭小兒術後鎮痛工作,開展1歲～3歲幼兒術後鎮痛的佔81.5％,1箇月～12箇月嬰兒術後鎮痛的佔55.6％,新生兒術後鎮痛僅有25.9％.超過80％的醫院建立瞭小兒術後鎮痛相關培訓,併有箇性化鎮痛方案和療效評估,但隻有59.3％的醫院安排有專門的小兒術後鎮痛人員,22.2％設置瞭術後鎮痛服務小組.所有開展小兒術後鎮痛的醫院均使用靜脈患者自控鎮痛(patient controlled analgesia,PCA),隻有25.9％醫院開展硬膜外PCA方式鎮痛.跼痳藥被廣汎用于小兒術後鎮痛,包括囉哌卡因、利多卡因和佈比卡因,阿片類藥物以舒芬太尼、芬太尼和麯馬多為主,經常使用非甾體類抗炎藥(non-steroid anti-inflammatory drugs,NSAIDs)的醫院僅佔29.6％,隻有11.1％的醫院經常使用對乙酰氨基酚. 結論 小兒術後鎮痛工作在我國兒童手術較多的大型綜閤性醫院和兒童醫院已經普遍開展,但嬰兒和新生兒的術後鎮痛工作有待加彊.有必要普及術後切口跼痳藥浸潤,更多開展外週神經阻滯;普及副作用少又經濟實用的對乙酰氨基酚類藥物的使用,增加NSAIDs的用量,加彊阿片類藥物治療安全的鑑控.
목적 료해당금국내소인술후진통공작재인동수술량교대적대형종합의원화인동의원적응용정황,위소인술후진통재국내추엄응용제공삼고. 방법 대전국예계소인마취년수술량초과1000례적40가의원적마취과진행료문권조사.31가의원완성조사,척제년소인수술량저우1 000례적4가,납입27가의원진행분석.조사적내용포괄의원진통관리상관정책화제도,소인술후진통개전정황,여개전진통적년령단、상용술후진통방식화약물、정맥진통빙배방、소인술후진통존재적문제등. 결과 납입분석적의원중88.9％개전료소인술후진통공작,개전1세～3세유인술후진통적점81.5％,1개월～12개월영인술후진통적점55.6％,신생인술후진통부유25.9％.초과80％적의원건립료소인술후진통상관배훈,병유개성화진통방안화료효평고,단지유59.3％적의원안배유전문적소인술후진통인원,22.2％설치료술후진통복무소조.소유개전소인술후진통적의원균사용정맥환자자공진통(patient controlled analgesia,PCA),지유25.9％의원개전경막외PCA방식진통.국마약피엄범용우소인술후진통,포괄라고잡인、리다잡인화포비잡인,아편류약물이서분태니、분태니화곡마다위주,경상사용비치체류항염약(non-steroid anti-inflammatory drugs,NSAIDs)적의원부점29.6％,지유11.1％적의원경상사용대을선안기분. 결론 소인술후진통공작재아국인동수술교다적대형종합성의원화인동의원이경보편개전,단영인화신생인적술후진통공작유대가강.유필요보급술후절구국마약침윤,경다개전외주신경조체;보급부작용소우경제실용적대을선안기분류약물적사용,증가NSAIDs적용량,가강아편류약물치료안전적감공.
Objective To improve postoperative care for children we investigated some tertiary general or children's hospitals.Methods Questionnaires for postoperative pain management were sent to anesthesia department of 40 hospitals,and 27 hospitals were accepted.We assessed the hospitals' analgesia system and the present situation of pediatric analgesic management including the age scope,the methods and medications,the recipe of patient controlled analgesia (PCA) pump.Results 88.9％ of the analyzed hospitals have applied postoperative analgesia in children,81.5％ in 1 y-3 y younger children,55.6％ in 1 month-12 month infants,but only 25.9％ in neonates.More than 80％ hospitals have established pediatric analgesia-relevant trainings,analgesia protocols and pain evaluations.However,only 59.3％ hospitals have arranged specialized staff to care children's postoperative analgesia,22.2％ have set up pediatric acute pain service team.Intravenous PCA has been applied in all the hospitals,however,epidural PCA utility ratio is 25.9％.Local anesthetics have been widely used for children's postoperative analgesia,including ropivacaine,lidocaine and bupivacaine.Sufentanil,fentanyl and tramadol dominate in opioids.Nevertheless,the utility ratio of non-steroid anti-inflammatory drugs (NSAIDs) and paracetamol is 29.6％ and 11.1％ respectively.Conclusions Postoperative analgesia in children has been widely applied in Chinese tertiary general or children's hospitals,but postoperative analgesia in infants and neonates is poor.It's essential to popularize local anesthetics infiltration,promote more peripheral nerve blocks for postoperative pain treatment in children.Paracetamol,inexpensive and effective with little side effects,should be used as the basic medication for either minor or larger surgeries.NSAIDs should be encouraged to use.The safety of using various opioids for postoperative pain treatment in Children should be closely monitored.
