Schiessl Christine, Gravou Chara, Zernikow Boris, Sittl Reinhard, Griessinger Norbert
Department of Palliative Medicine, University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
Support Care Cancer. 2008 May;16(5):531-6. doi: 10.1007/s00520-008-0408-2. Epub 2008 Feb 15.
In the last week of life, the daily opioid dose in children is highly variable, making the use of patient-controlled analgesia (PCA) a useful therapy option. Scientific data on the use of PCA in paediatric palliative care are rare.
Retrospective chart review over a 7-year period (Jan 1998-Jan 2005) of PCA treated children dying of cancer was used.
Eight children were on PCA for a median duration of 9 days (range, 1 to 50). The daily median intravenous morphine equivalent dose referenced to body weight increased significantly when PCA was initiated and during the last week of life. In the last week of life, the median daily number of delivered and undelivered bolus requests ranged from 7.5-21 and 0-4.5, respectively. To meet children's individual needs, 39 PCA parametre changes on 22 opportunities were performed. Median daily mean pain scores remained low (range, 0-3; numerical rating scale 0-10) throughout the period.
PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect.
在生命的最后一周，儿童每日阿片类药物剂量变化很大，这使得患者自控镇痛（PCA）成为一种有用的治疗选择。关于PCA在儿科姑息治疗中应用的科学数据很少。
对1998年1月至2005年1月期间接受PCA治疗的8例死于癌症的儿童进行了为期7年的回顾性病历审查。
8例儿童接受PCA治疗的中位持续时间为9天（范围1至50天）。以体重为参考的每日静脉注射吗啡等效剂量中位数在开始使用PCA时和生命的最后一周显著增加。在生命的最后一周，已给药和未给药推注请求的每日中位数分别为7.5至21次和0至4.5次。为满足儿童的个体需求，在22次机会中对PCA参数进行了39次更改。在此期间，每日平均疼痛评分中位数一直较低（范围0至3；数字评分量表0至10）。
PCA被证明是一种理想、可靠且可行的镇痛给药方式，可根据个体情况调整剂量以达到效果。
