Anghelescu Doralina L, Burgoyne Laura L, Oakes Linda L, Wallace Debora A
Division of *Anesthesia and †Nursing Research and Patient Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee.
Anesth Analg. 2005 Dec;101(6):1623-1627. doi: 10.1213/01.ANE.0000184198.13285.33.
Between February 1999 and December 2003, we studied the use of patient-controlled analgesia (PCA) to control pain in 1011 children and young adults with cancer, by evaluating 4972 24-h periods of PCA usage, 576 of which involved PCA by proxy. Selection of patients for PCA by proxy was based on younger age group, neuromuscular limitation, expectation of repeated painful procedures, and terminal disease. We measured the incidence of respiratory and neurological complications related to the use of PCA. Major complications were observed during 70 of the 4972 24-h observations, with 28 of 4972, or 0.56%, involving respiratory complications, 35 of 4972, or 0.7%, involving neurological complications, and 7 of 4972 24-h observations, or 0.14%, involving both respiratory and neurological complications. In the PCA by proxy group two respiratory complications, two neurological complications and one mixed respiratory and neurological complication were observed [corrected] Reversal of opioid-related respiratory or neurological effects with naloxone was required in three instances, two in the standard PCA group and one in the PCA by proxy group. Recommendations to ensure continuing safety include careful patient selection, education of proxy users, appropriate documentation, and institutional guidelines.
1999年2月至2003年12月期间，我们通过评估4972个24小时的患者自控镇痛（PCA）使用时段，研究了PCA在1011例癌症儿童和青年患者中控制疼痛的应用情况，其中576个时段涉及代理PCA。代理PCA患者的选择基于年龄较小、神经肌肉受限、预期有重复的疼痛操作以及晚期疾病。我们测量了与PCA使用相关的呼吸和神经并发症的发生率。在4972个24小时观察时段中，有70个观察到主要并发症，4972个时段中有28个（0.56%）涉及呼吸并发症，4972个时段中有35个（0.7%）涉及神经并发症，4972个24小时观察时段中有7个（0.14%）涉及呼吸和神经并发症。在代理PCA组中，观察到2例呼吸并发症、2例神经并发症和1例呼吸与神经混合并发症[已修正]。在3例中需要用纳洛酮逆转与阿片类药物相关的呼吸或神经效应，2例在标准PCA组，1例在代理PCA组。确保持续安全的建议包括仔细选择患者、对代理使用者进行教育、适当记录以及制定机构指南。
