Duval M, Legrand F, Faye A, Escot A, Vernois S, Rohrlich P, Wood C, Bockenmeyer J, Vilmer E
Service d'hémato-immunologie, hôpital Robert-Debré, Paris, France.
Arch Pediatr. 2000 May;7(5):474-80. doi: 10.1016/s0929-693x(00)89002-8.
Patient-controlled analgesia (PCA) has been shown to be superior to a continuous morphine infusion for the treatment of ongoing pain in children over five years of age. Nevertheless, prescription parameters such as the bolus dosage and the possible association of a continuous background infusion have not yet been standardized.
Thirty-three children, aged four to 17, hospitalized in a pediatric hematology ward, benefited from PCA with a standardized prescription: a bolus dosage of at least 25 mg/kg, without a background infusion. Morphine consumption, side effects and efficacy on pain relief were followed.
Median of mean morphine consumption was 0.32 mg.kg-1.d-1. Median of maximal consumption was 0.58 mg.kg-1.d-1. Mean duration was nine days. No important side effects were noted, except in two patients. They presented prolonged constipation and a poor quality of nocturnal sleep, but they also had a major depressive syndrome persisting after resolution of pain. Efficacy was comparable to a continuous intravenous infusion, and nocturnal sleep was of good quality for 31 children.
This standardized technique of PCA can be used extensively in children over five years of age. It can be used as a reference for further studies.
对于五岁以上儿童持续性疼痛的治疗，患者自控镇痛（PCA）已被证明优于持续静脉输注吗啡。然而，如单次给药剂量和持续背景输注可能存在的联合使用等处方参数尚未标准化。
33名年龄在4至17岁之间、住院于儿科血液科病房的儿童，受益于标准化处方的PCA：单次给药剂量至少25mg/kg，无背景输注。对吗啡消耗量、副作用及疼痛缓解效果进行跟踪。
平均吗啡消耗量中位数为0.32mg·kg-1·d-1。最大消耗量中位数为0.58mg·kg-1·d-1。平均持续时间为9天。除两名患者外，未观察到严重副作用。这两名患者出现了长期便秘和夜间睡眠质量差的情况，但他们在疼痛缓解后还存在持续的重度抑郁综合征。疗效与持续静脉输注相当，31名儿童夜间睡眠质量良好。
这种标准化的PCA技术可广泛应用于五岁以上儿童。它可为进一步研究提供参考。
